What does it mean when there is an annotation next to the patient orientation icon?

Depending on the current value of the Patient Orientation user setting, it is possible that in some cases an annotation can appear next to the patient orientation icon in the main axial view, as shown in the following screenshot:

In this case the patient orientation icon is annotated with "Planning Orientation" to indicate that the current orientation is derived from the currently active treatment plan and that the plan's orientation differs from the orientation of its parent CT images. In general this message is presented to make you aware that the current orientation is different from the derived orientation from the primary image set or active plan. Specifically, the various annotations that can appear (and the situations under which they can occur) are enumerated below:

• Planning Orientation. This annotation can only appear if using one of the plan-based settings for Patient Orientation (i.e., "Planning Orientation (or Image Orientation if not available)" or "Planning Orientation (or Head First Image Orientation if not available)"). If the annotation appears, it indicates that one of two situations have occurred, either (1) the currently active plan has a different patient orientation than its parent images or (2) the parent images have been reoriented to be head first and the annotation is shown to indicate that the planning orientation is currently being utilized.
• Image Orientation. This annotation can only appear if using the "Image Orientation" setting for Patient Orientation. If the annotation appears, it indicates that the current patient orientation is being determined from the active image set and that this orientation differs from what is specified in the active plan (i.e., the plan orientation is being overridden by the image set orientation).
• Head First Image Orientation. This annotation can appear if using one of the the head first settings for Patient Orientation (i.e., "Planning Orientation (or Head First Image Orientation if not available)" or "Head First Image Orientation"). If the annotation appears, it indicates that the derived patient orientation from the active image set is being overridden by its head first equivalent.