By default, when you generate a DRR, the image is oriented as if the virtual x-ray source were a camera. That means that for a right lateral film, the columns of the image go from inf to sup, and the rows go from ant to post. The Varian OBI system produces HND files, which are oriented differently. For a right lateral film, the columns of the HND images go from ant to post, and the rows go from sup to inf. An illustration of this idea is shown in the figure below.
Geometry of Varian HND files