I can’t see an option for QGIS export. It’s all about the end user. The architect with a low spec workstation. 5MB JPG’s with white background so S/he can plot on white paper.
I can spin it around in CAD, but I will have lost my Z to Y coordinate. The whole export with image coordinates is tricky. We need to know the Z value in the bottom left-hand corner. I have had to work around this uncertainty by using a reconstruction region to ground control points for which I know the Z value therefore the base level of the box.
If you are exporting the georeferenced ortho, the Z values are there, you just need to use one plugin for AutoCAD (it is mentioned in the attached comments). Then you will be able to measure the height of the bottom left-hand corner.