Thank you both for your replies.
@zivy A bit scary considering that Nifti is becoming more and more the standard for processing pipelines. Even BIDS that is taking a lot of attention nowadays is basically based on Niftis. I opened a related post to this in the BIDS Discourse (Neurostar) related to this topic: https://neurostars.org/t/direction-orientation-matrix-dicom-vs-nifti/14382
@dzenanz Much before … We are using ITK 4.11.0 and tricky to move to ITK 5 as it is already used/linked in multiple tools running with 4.11. Thanks for the info anyways! Basically, does this patch increase the precision in the Niftis q_form to make it more compatible with the original values in the itkImage ?