diff --git a/packages/tools/src/utilities/orientation/getOrientationStringLPS.spec.ts b/packages/tools/src/utilities/orientation/getOrientationStringLPS.spec.ts
new file mode 100644
index 0000000000..6de9bddbe9
--- /dev/null
+++ b/packages/tools/src/utilities/orientation/getOrientationStringLPS.spec.ts
@@ -0,0 +1,110 @@
+import { describe, expect, it } from '@jest/globals';
+import getOrientationStringLPS from './getOrientationStringLPS';
+import invertOrientationStringLPS from './invertOrientationStringLPS';
+import {
+  BIPED_ORIENTATION_LABELS,
+  QUADRUPED_TRUNK_ORIENTATION_LABELS,
+  QUADRUPED_HEAD_ORIENTATION_LABELS,
+} from './orientationLabels';
+
+describe('getOrientationStringLPS', () => {
+  describe('biped (default, human)', () => {
+    it('maps each patient axis to its anatomical designator', () => {
+      expect(getOrientationStringLPS([1, 0, 0])).toBe('L'); // +X Left
+      expect(getOrientationStringLPS([-1, 0, 0])).toBe('R'); // -X Right
+      expect(getOrientationStringLPS([0, 1, 0])).toBe('P'); // +Y Posterior
+      expect(getOrientationStringLPS([0, -1, 0])).toBe('A'); // -Y Anterior
+      expect(getOrientationStringLPS([0, 0, 1])).toBe('H'); // +Z Head
+      expect(getOrientationStringLPS([0, 0, -1])).toBe('F'); // -Z Foot
+    });
+
+    it('combines designators for oblique directions', () => {
+      expect(getOrientationStringLPS([1, 1, 0])).toBe('LP');
+      expect(getOrientationStringLPS([1, 0, 1])).toBe('LH');
+    });
+
+    it('matches the explicitly passed biped labels', () => {
+      expect(getOrientationStringLPS([1, 0, 0], BIPED_ORIENTATION_LABELS)).toBe(
+        'L'
+      );
+    });
+  });
+
+  describe('quadruped trunk (veterinary)', () => {
+    it('maps the Z axis to cranial/caudal', () => {
+      expect(
+        getOrientationStringLPS([0, 0, 1], QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('CR'); // +Z Cranial
+      expect(
+        getOrientationStringLPS([0, 0, -1], QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('CD'); // -Z Caudal
+    });
+
+    it('shares left/right and dorsal/ventral with the head frame', () => {
+      expect(
+        getOrientationStringLPS([1, 0, 0], QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('LE'); // +X Left
+      expect(
+        getOrientationStringLPS([0, -1, 0], QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('V'); // -Y Ventral
+    });
+
+    it('combines multi-letter designators without delimiters', () => {
+      // Left + Ventral, matching the DICOM "LEV" style example.
+      expect(
+        getOrientationStringLPS([1, -1, 0], QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('LEV');
+    });
+  });
+
+  describe('quadruped head (veterinary)', () => {
+    it('maps the Z axis to rostral/caudal instead of cranial/caudal', () => {
+      expect(
+        getOrientationStringLPS([0, 0, 1], QUADRUPED_HEAD_ORIENTATION_LABELS)
+      ).toBe('R'); // +Z Rostral (toward the nose)
+      expect(
+        getOrientationStringLPS([0, 0, -1], QUADRUPED_HEAD_ORIENTATION_LABELS)
+      ).toBe('CD'); // -Z Caudal
+    });
+  });
+});
+
+describe('invertOrientationStringLPS', () => {
+  describe('biped (default, human)', () => {
+    it('swaps each designator for its opposite', () => {
+      expect(invertOrientationStringLPS('L')).toBe('R');
+      expect(invertOrientationStringLPS('P')).toBe('A');
+      expect(invertOrientationStringLPS('H')).toBe('F');
+      expect(invertOrientationStringLPS('LPS')).toBe('RAS');
+      expect(invertOrientationStringLPS('HF')).toBe('FH');
+    });
+  });
+
+  describe('quadruped trunk (veterinary)', () => {
+    it('swaps single- and multi-letter designators for their opposites', () => {
+      expect(
+        invertOrientationStringLPS('LE', QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('RT');
+      expect(
+        invertOrientationStringLPS('D', QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('V');
+      expect(
+        invertOrientationStringLPS('CR', QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('CD');
+      expect(
+        invertOrientationStringLPS('LECD', QUADRUPED_TRUNK_ORIENTATION_LABELS)
+      ).toBe('RTCR');
+    });
+  });
+
+  describe('quadruped head (veterinary)', () => {
+    it('swaps rostral and caudal', () => {
+      expect(
+        invertOrientationStringLPS('R', QUADRUPED_HEAD_ORIENTATION_LABELS)
+      ).toBe('CD');
+      expect(
+        invertOrientationStringLPS('CD', QUADRUPED_HEAD_ORIENTATION_LABELS)
+      ).toBe('R');
+    });
+  });
+});
diff --git a/packages/tools/src/utilities/orientation/getOrientationStringLPS.ts b/packages/tools/src/utilities/orientation/getOrientationStringLPS.ts
index 0aaf9d699d..56f37c367d 100644
--- a/packages/tools/src/utilities/orientation/getOrientationStringLPS.ts
+++ b/packages/tools/src/utilities/orientation/getOrientationStringLPS.ts
@@ -1,20 +1,31 @@
 import type { Types } from '@cornerstonejs/core';
+import {
+  BIPED_ORIENTATION_LABELS,
+  type OrientationLabels,
+} from './orientationLabels';
 
 /**
  * Returns the orientation of the vector in the patient coordinate system.
  * @public
  *
  * @param vector - Input array
+ * @param labels - Designators to use for each patient axis. Defaults to the
+ *   human (biped) set; pass {@link QUADRUPED_TRUNK_ORIENTATION_LABELS} or
+ *   {@link QUADRUPED_HEAD_ORIENTATION_LABELS} for veterinary imaging, per
+ *   DICOM PS3.3 C.7.6.1.1.1 (quadruped designators are body-region-specific).
  * @returns The orientation in the patient coordinate system.
  */
-export default function getOrientationStringLPS(vector: Types.Point3): string {
+export default function getOrientationStringLPS(
+  vector: Types.Point3,
+  labels: OrientationLabels = BIPED_ORIENTATION_LABELS
+): string {
   // Thanks to David Clunie
   // https://sites.google.com/site/dicomnotes/
 
   let orientation = '';
-  const orientationX = vector[0] < 0 ? 'R' : 'L';
-  const orientationY = vector[1] < 0 ? 'A' : 'P';
-  const orientationZ = vector[2] < 0 ? 'F' : 'H';
+  const orientationX = vector[0] < 0 ? labels.negativeX : labels.positiveX;
+  const orientationY = vector[1] < 0 ? labels.negativeY : labels.positiveY;
+  const orientationZ = vector[2] < 0 ? labels.negativeZ : labels.positiveZ;
 
   // Should probably make this a function vector3.abs
   const abs = [Math.abs(vector[0]), Math.abs(vector[1]), Math.abs(vector[2])];
diff --git a/packages/tools/src/utilities/orientation/index.ts b/packages/tools/src/utilities/orientation/index.ts
index 1d77e4600c..a8c9cafcec 100644
--- a/packages/tools/src/utilities/orientation/index.ts
+++ b/packages/tools/src/utilities/orientation/index.ts
@@ -1,4 +1,17 @@
 import getOrientationStringLPS from './getOrientationStringLPS';
 import invertOrientationStringLPS from './invertOrientationStringLPS';
+import {
+  BIPED_ORIENTATION_LABELS,
+  QUADRUPED_TRUNK_ORIENTATION_LABELS,
+  QUADRUPED_HEAD_ORIENTATION_LABELS,
+  type OrientationLabels,
+} from './orientationLabels';
 
-export { getOrientationStringLPS, invertOrientationStringLPS };
+export {
+  getOrientationStringLPS,
+  invertOrientationStringLPS,
+  BIPED_ORIENTATION_LABELS,
+  QUADRUPED_TRUNK_ORIENTATION_LABELS,
+  QUADRUPED_HEAD_ORIENTATION_LABELS,
+  type OrientationLabels,
+};
diff --git a/packages/tools/src/utilities/orientation/invertOrientationStringLPS.ts b/packages/tools/src/utilities/orientation/invertOrientationStringLPS.ts
index 75fd4d8f19..32c2244157 100644
--- a/packages/tools/src/utilities/orientation/invertOrientationStringLPS.ts
+++ b/packages/tools/src/utilities/orientation/invertOrientationStringLPS.ts
@@ -1,21 +1,53 @@
+import {
+  BIPED_ORIENTATION_LABELS,
+  type OrientationLabels,
+} from './orientationLabels';
+
 /**
- * Inverts an orientation string.
+ * Inverts an orientation string by replacing every designator with the one
+ * pointing along the opposite patient axis.
  * @public
  *
  * @param orientationString - The orientation.
+ * @param labels - Designators per patient axis. Must match the set used to
+ *   produce `orientationString`. Defaults to the human (biped) set; pass
+ *   {@link QUADRUPED_TRUNK_ORIENTATION_LABELS} or
+ *   {@link QUADRUPED_HEAD_ORIENTATION_LABELS} for veterinary strings.
  * @returns The inverted orientationString.
  */
 export default function invertOrientationStringLPS(
-  orientationString: string
+  orientationString: string,
+  labels: OrientationLabels = BIPED_ORIENTATION_LABELS
 ): string {
-  let inverted = orientationString.replace('H', 'f');
+  // Opposite-direction pairs along each patient axis.
+  const oppositePairs: ReadonlyArray<readonly [string, string]> = [
+    [labels.positiveX, labels.negativeX],
+    [labels.positiveY, labels.negativeY],
+    [labels.positiveZ, labels.negativeZ],
+  ];
+
+  // Map each designator to its opposite. Longest first so multi-letter
+  // veterinary abbreviations (e.g. "CR"/"CD") match before a single letter,
+  // as described in DICOM PS3.3 C.7.6.1.1.1 (parseable left-to-right).
+  const swaps: Array<[string, string]> = oppositePairs
+    .flatMap(([a, b]) => [
+      [a, b] as [string, string],
+      [b, a] as [string, string],
+    ])
+    .sort((left, right) => right[0].length - left[0].length);
 
-  inverted = inverted.replace('F', 'h');
-  inverted = inverted.replace('R', 'l');
-  inverted = inverted.replace('L', 'r');
-  inverted = inverted.replace('A', 'p');
-  inverted = inverted.replace('P', 'a');
-  inverted = inverted.toUpperCase();
+  let inverted = '';
+  for (let i = 0; i < orientationString.length; ) {
+    const swap = swaps.find(([from]) => orientationString.startsWith(from, i));
+    if (swap) {
+      inverted += swap[1];
+      i += swap[0].length;
+    } else {
+      // Preserve any character that is not a known designator (e.g. a delimiter).
+      inverted += orientationString[i];
+      i += 1;
+    }
+  }
 
   return inverted;
 }
diff --git a/packages/tools/src/utilities/orientation/orientationLabels.ts b/packages/tools/src/utilities/orientation/orientationLabels.ts
new file mode 100644
index 0000000000..084fa66065
--- /dev/null
+++ b/packages/tools/src/utilities/orientation/orientationLabels.ts
@@ -0,0 +1,102 @@
+/**
+ * Orientation label designators for the patient-based coordinate system (LPS),
+ * as defined in DICOM PS3.3 Section C.7.6.1.1.1 (Patient Orientation).
+ *
+ * The geometric axes are identical for every species; only the anatomical
+ * designator letters differ. The `AnatomicalOrientationType` (0010,2210)
+ * attribute selects which set applies:
+ *
+ * - `BIPED` (human, the default when absent) — a single universal mapping,
+ *   see {@link BIPED_ORIENTATION_LABELS}.
+ * - `QUADRUPED` (veterinary) — **body-region-specific**. DICOM lists many
+ *   quadruped designators (rostral, proximal, distal, palmar, plantar, ...)
+ *   precisely because no single mapping covers every study:
+ *   - **trunk, neck, tail** → cranial/caudal on the Z axis
+ *     ({@link QUADRUPED_TRUNK_ORIENTATION_LABELS})
+ *   - **head** → rostral/caudal on the Z axis
+ *     ({@link QUADRUPED_HEAD_ORIENTATION_LABELS})
+ *   - **limbs** → proximal/distal along the limb; the designators depend on
+ *     limb positioning, so there is no fixed-axis preset. Callers must build
+ *     a region-appropriate {@link OrientationLabels} from the DICOM designators
+ *     (PR/DI proximal-distal, PA palmar, PL plantar, ...) for each study.
+ *
+ * @public
+ */
+export type OrientationLabels = {
+  /** Designator for the +X axis (toward the patient's left side). */
+  positiveX: string;
+  /** Designator for the -X axis (toward the patient's right side). */
+  negativeX: string;
+  /** Designator for the +Y axis (posterior / dorsal side). */
+  positiveY: string;
+  /** Designator for the -Y axis (anterior / ventral side). */
+  negativeY: string;
+  /** Designator for the +Z axis (toward the head / cranial direction). */
+  positiveZ: string;
+  /** Designator for the -Z axis (toward the feet / caudal direction). */
+  negativeZ: string;
+};
+
+/**
+ * Human (biped) orientation designators. Used when `AnatomicalOrientationType`
+ * (0010,2210) is absent or has the value `BIPED`. The biped mapping is
+ * universal, so this is the historical default and keeps existing behavior
+ * unchanged.
+ *
+ * @public
+ */
+export const BIPED_ORIENTATION_LABELS: OrientationLabels = {
+  positiveX: 'L', // Left
+  negativeX: 'R', // Right
+  positiveY: 'P', // Posterior
+  negativeY: 'A', // Anterior
+  positiveZ: 'H', // Head
+  negativeZ: 'F', // Foot
+};
+
+/**
+ * Veterinary (quadruped) designators for the **trunk, neck and tail** — the
+ * standard whole-body cranial-caudal frame. This is the mapping used in the
+ * worked example of DICOM PS3.3 C.7.6.1.1.1 (a quadruped abdomen view encoded
+ * "LEV\\CD"), and cranial/caudal apply to the neck, trunk and tail per
+ * veterinary anatomy.
+ *
+ * - +X/-X = Left/Right (LE/RT)
+ * - +Y/-Y = Dorsal/Ventral (D/V)
+ * - +Z/-Z = Cranial/Caudal (CR/CD)
+ *
+ * Do not use this preset for the head or limbs — see
+ * {@link QUADRUPED_HEAD_ORIENTATION_LABELS} and the limb note above.
+ *
+ * @public
+ */
+export const QUADRUPED_TRUNK_ORIENTATION_LABELS: OrientationLabels = {
+  positiveX: 'LE', // Left
+  negativeX: 'RT', // Right
+  positiveY: 'D', // Dorsal
+  negativeY: 'V', // Ventral
+  positiveZ: 'CR', // Cranial
+  negativeZ: 'CD', // Caudal
+};
+
+/**
+ * Veterinary (quadruped) designators for the **head**. Identical to the trunk
+ * frame except the +Z/-Z axis is rostral/caudal (R/CD): "rostral" points
+ * toward the nose and is used only for the head, while cranial/caudal apply to
+ * the neck, trunk and tail (per veterinary anatomy). Dorsal/ventral and
+ * left/right still apply to the head.
+ *
+ * - +X/-X = Left/Right (LE/RT)
+ * - +Y/-Y = Dorsal/Ventral (D/V)
+ * - +Z/-Z = Rostral/Caudal (R/CD)
+ *
+ * @public
+ */
+export const QUADRUPED_HEAD_ORIENTATION_LABELS: OrientationLabels = {
+  positiveX: 'LE', // Left
+  negativeX: 'RT', // Right
+  positiveY: 'D', // Dorsal
+  negativeY: 'V', // Ventral
+  positiveZ: 'R', // Rostral
+  negativeZ: 'CD', // Caudal
+};