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.
This is also odd behaviour.
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.