diff --git a/common/reviews/api/tools.api.md b/common/reviews/api/tools.api.md
index 6dadd7ce47..4dace9b2c1 100644
--- a/common/reviews/api/tools.api.md
+++ b/common/reviews/api/tools.api.md
@@ -1690,6 +1690,9 @@ function debounce(func: Function, wait?: number, options?: {
     trailing?: boolean;
 }): Function;
 
+// @public (undocumented)
+function decimate(polyline: Types_2.Point2[], epsilon?: number): Types_2.Point2[];
+
 // @public (undocumented)
 const _default: {
     filterAnnotationsWithinSlice: typeof filterAnnotationsWithinSlice;
@@ -3828,6 +3831,7 @@ declare namespace polyline {
         getNormal3,
         getNormal2,
         intersectPolyline,
+        decimate,
         getFirstLineSegmentIntersectionIndexes,
         getLineSegmentIntersectionsIndexes,
         getLineSegmentIntersectionsCoordinates,
@@ -5745,6 +5749,11 @@ function updateContourPolyline(annotation: ContourAnnotation, polylineData: {
     targetWindingDirection?: ContourWindingDirection;
 }, transforms: {
     canvasToWorld: (point: Types_2.Point2) => Types_2.Point3;
+}, options?: {
+    decimate?: {
+        enabled?: boolean;
+        epsilon?: number;
+    };
 }): void;
 
 declare namespace utilities {
diff --git a/packages/tools/src/eventListeners/annotations/contourSegmentation/contourSegmentationCompleted.ts b/packages/tools/src/eventListeners/annotations/contourSegmentation/contourSegmentationCompleted.ts
index f93e89ca85..c98244656e 100644
--- a/packages/tools/src/eventListeners/annotations/contourSegmentation/contourSegmentationCompleted.ts
+++ b/packages/tools/src/eventListeners/annotations/contourSegmentation/contourSegmentationCompleted.ts
@@ -242,7 +242,7 @@ function getContourHolesData(
   });
 }
 
-async function combinePolylines(
+function combinePolylines(
   viewport: Types.IViewport,
   targetAnnotation: ContourSegmentationAnnotation,
   targetPolyline: Types.Point2[],
diff --git a/packages/tools/src/tools/annotation/LivewireContourTool.ts b/packages/tools/src/tools/annotation/LivewireContourTool.ts
index 585e3e209d..a297ed9d9a 100644
--- a/packages/tools/src/tools/annotation/LivewireContourTool.ts
+++ b/packages/tools/src/tools/annotation/LivewireContourTool.ts
@@ -32,7 +32,6 @@ import { LivewireScissors } from '../../utilities/livewire/LivewireScissors';
 import { LivewirePath } from '../../utilities/livewire/LiveWirePath';
 import { getViewportIdsWithToolToRender } from '../../utilities/viewportFilters';
 import ContourSegmentationBaseTool from '../base/ContourSegmentationBaseTool';
-import updateContourPolyline from '../../utilities/contours/updateContourPolyline';
 
 const CLICK_CLOSE_CURVE_SQR_DIST = 10 ** 2; // px
 
@@ -108,6 +107,20 @@ class LivewireContourTool extends ContourSegmentationBaseTool {
            */
           showInterpolationPolyline: false,
         },
+
+        /**
+         * The polyline may get processed in order to reduce the number of points
+         * for better performance and storage.
+         */
+        decimate: {
+          enabled: false,
+          /** A maximum given distance 'epsilon' to decide if a point should or
+           * shouldn't be added the resulting polyline which will have a lower
+           * number of points for higher `epsilon` values.
+           */
+          epsilon: 0.1,
+        },
+
         actions: {
           undo: {
             method: 'undo',
@@ -922,7 +935,7 @@ class LivewireContourTool extends ContourSegmentationBaseTool {
       imagePoints = [...imagePoints, imagePoints[0]];
     }
 
-    updateContourPolyline(
+    this.updateContourPolyline(
       annotation,
       {
         points: imagePoints,
diff --git a/packages/tools/src/tools/annotation/PlanarFreehandROITool.ts b/packages/tools/src/tools/annotation/PlanarFreehandROITool.ts
index 20e26e997a..48a597bf5a 100644
--- a/packages/tools/src/tools/annotation/PlanarFreehandROITool.ts
+++ b/packages/tools/src/tools/annotation/PlanarFreehandROITool.ts
@@ -231,6 +231,18 @@ class PlanarFreehandROITool extends ContourSegmentationBaseTool {
           // interpolation is complete.
           onInterpolationComplete: null,
         },
+        /**
+         * The polyline may get processed in order to reduce the number of points
+         * for better performance and storage.
+         */
+        decimate: {
+          enabled: false,
+          /** A maximum given distance 'epsilon' to decide if a point should or
+           * shouldn't be added the resulting polyline which will have a lower
+           * number of points for higher `epsilon` values.
+           */
+          epsilon: 0.1,
+        },
         calculateStats: false,
         getTextLines: defaultGetTextLines,
         statsCalculator: BasicStatsCalculator,
diff --git a/packages/tools/src/tools/annotation/SplineROITool.ts b/packages/tools/src/tools/annotation/SplineROITool.ts
index b54789aa2f..fce37f1de3 100644
--- a/packages/tools/src/tools/annotation/SplineROITool.ts
+++ b/packages/tools/src/tools/annotation/SplineROITool.ts
@@ -56,7 +56,6 @@ import { LinearSpline } from './splines/LinearSpline';
 import { CatmullRomSpline } from './splines/CatmullRomSpline';
 import { BSpline } from './splines/BSpline';
 import ContourSegmentationBaseTool from '../base/ContourSegmentationBaseTool';
-import updateContourPolyline from '../../utilities/contours/updateContourPolyline';
 
 const SPLINE_MIN_POINTS = 3;
 const SPLINE_CLICK_CLOSE_CURVE_DIST = 10;
@@ -121,6 +120,18 @@ class SplineROITool extends ContourSegmentationBaseTool {
          * modifier must be pressed when the first point of a new contour is added.
          */
         contourHoleAdditionModifierKey: KeyboardBindings.Shift,
+        /**
+         * The polyline may get processed in order to reduce the number of points
+         * for better performance and storage.
+         */
+        decimate: {
+          enabled: false,
+          /** A maximum given distance 'epsilon' to decide if a point should or
+           * shouldn't be added the resulting polyline which will have a lower
+           * number of points for higher `epsilon` values.
+           */
+          epsilon: 0.1,
+        },
         spline: {
           configuration: {
             [SplineTypesEnum.Cardinal]: {
@@ -693,7 +704,7 @@ class SplineROITool extends ContourSegmentationBaseTool {
         const spline = this._updateSplineInstance(element, annotation);
         const splinePolylineCanvas = spline.getPolylinePoints();
 
-        updateContourPolyline(
+        this.updateContourPolyline(
           annotation,
           {
             points: splinePolylineCanvas,
diff --git a/packages/tools/src/tools/annotation/planarFreehandROITool/drawLoop.ts b/packages/tools/src/tools/annotation/planarFreehandROITool/drawLoop.ts
index df030c61aa..b471fff7b5 100644
--- a/packages/tools/src/tools/annotation/planarFreehandROITool/drawLoop.ts
+++ b/packages/tools/src/tools/annotation/planarFreehandROITool/drawLoop.ts
@@ -18,7 +18,6 @@ import { PlanarFreehandROIAnnotation } from '../../../types/ToolSpecificAnnotati
 import findOpenUShapedContourVectorToPeak from './findOpenUShapedContourVectorToPeak';
 import { polyline } from '../../../utilities/math';
 import { removeAnnotation } from '../../../stateManagement/annotation/annotationState';
-import { updateContourPolyline } from '../../../utilities/contours/';
 import reverseIfAntiClockwise from '../../../utilities/contours/reverseIfAntiClockwise';
 
 const {
@@ -238,7 +237,7 @@ function completeDrawClosedContour(
   // contours. A future optimization if we use this for segmentation is to re-do
   // this rendering with the GPU rather than SVG.
 
-  updateContourPolyline(
+  this.updateContourPolyline(
     annotation,
     {
       points: updatedPoints,
@@ -315,7 +314,7 @@ function completeDrawOpenContour(
   // contours. A future optimisation if we use this for segmentation is to re-do
   // this rendering with the GPU rather than SVG.
 
-  updateContourPolyline(
+  this.updateContourPolyline(
     annotation,
     {
       points: updatedPoints,
diff --git a/packages/tools/src/tools/base/ContourBaseTool.ts b/packages/tools/src/tools/base/ContourBaseTool.ts
index 5cdda04e28..667d6e2b6f 100644
--- a/packages/tools/src/tools/base/ContourBaseTool.ts
+++ b/packages/tools/src/tools/base/ContourBaseTool.ts
@@ -17,7 +17,9 @@ import type {
 import { drawPath as drawPathSvg } from '../../drawingSvg';
 import { StyleSpecifier } from '../../types/AnnotationStyle';
 import AnnotationTool from './AnnotationTool';
+import { updateContourPolyline } from '../../utilities/contours/';
 import { getContourHolesDataCanvas } from '../../utilities/contours';
+import { ContourWindingDirection } from '../../types/ContourAnnotation';
 
 /**
  * A contour base class responsible for rendering contour instances such as
@@ -210,6 +212,27 @@ abstract class ContourBaseTool extends AnnotationTool {
     );
   }
 
+  protected updateContourPolyline(
+    annotation: ContourAnnotation,
+    polylineData: {
+      points: Types.Point2[];
+      closed?: boolean;
+      targetWindingDirection?: ContourWindingDirection;
+    },
+    transforms: {
+      canvasToWorld: (point: Types.Point2) => Types.Point3;
+    }
+  ) {
+    const decimateConfig = this.configuration?.decimate || {};
+
+    updateContourPolyline(annotation, polylineData, transforms, {
+      decimate: {
+        enabled: !!decimateConfig.enabled,
+        epsilon: decimateConfig.epsilon,
+      },
+    });
+  }
+
   /**
    * Get polyline points in world space.
    * Just to give a chance for child classes to override it.
diff --git a/packages/tools/src/utilities/contours/updateContourPolyline.ts b/packages/tools/src/utilities/contours/updateContourPolyline.ts
index df44167563..b42d9943db 100644
--- a/packages/tools/src/utilities/contours/updateContourPolyline.ts
+++ b/packages/tools/src/utilities/contours/updateContourPolyline.ts
@@ -14,6 +14,12 @@ import {
  * @param viewport - Viewport
  * @param polylineData - Polyline data (points, winding direction and closed)
  * @param transforms - Methods to convert points to/from canvas and world spaces
+ * @param options - Options
+ *   - decimate: allow to set some parameters to decimate the polyline reducing
+ *   the amount of points stored which also affects how fast it will draw the
+ *   annotation in a viewport, compute the winding direction, append/remove
+ *   contours and create holes. A higher `epsilon` value results in a polyline
+ *   with less points.
  */
 export default function updateContourPolyline(
   annotation: ContourAnnotation,
@@ -24,11 +30,27 @@ export default function updateContourPolyline(
   },
   transforms: {
     canvasToWorld: (point: Types.Point2) => Types.Point3;
+  },
+  options?: {
+    decimate?: {
+      enabled?: boolean;
+      epsilon?: number;
+    };
   }
 ) {
   const { canvasToWorld } = transforms;
   const { data } = annotation;
-  const { points: polyline, targetWindingDirection } = polylineData;
+  const { targetWindingDirection } = polylineData;
+  let { points: polyline } = polylineData;
+
+  // Decimate the polyline to reduce tha amount of points
+  if (options?.decimate?.enabled) {
+    polyline = math.polyline.decimate(
+      polylineData.points,
+      options?.decimate?.epsilon
+    );
+  }
+
   let { closed } = polylineData;
   const numPoints = polyline.length;
   const polylineWorldPoints = new Array(numPoints);
diff --git a/packages/tools/src/utilities/math/line/distanceToPointSquaredInfo.ts b/packages/tools/src/utilities/math/line/distanceToPointSquaredInfo.ts
index f7a11570a5..7ea5763a8c 100644
--- a/packages/tools/src/utilities/math/line/distanceToPointSquaredInfo.ts
+++ b/packages/tools/src/utilities/math/line/distanceToPointSquaredInfo.ts
@@ -24,7 +24,8 @@ export default function distanceToPointSquaredInfo(
   let closestPoint: Types.Point2;
   const distanceSquared = math.point.distanceToPointSquared(lineStart, lineEnd);
 
-  // Check if lineStart is the same as lineEnd which means
+  // Check if lineStart equal to the lineEnd which means the closest point
+  // is any of these two points
   if (lineStart[0] === lineEnd[0] && lineStart[1] === lineEnd[1]) {
     closestPoint = lineStart;
   }
diff --git a/packages/tools/src/utilities/math/polyline/decimate.ts b/packages/tools/src/utilities/math/polyline/decimate.ts
new file mode 100644
index 0000000000..c0c8b376b1
--- /dev/null
+++ b/packages/tools/src/utilities/math/polyline/decimate.ts
@@ -0,0 +1,105 @@
+import type { Types } from '@cornerstonejs/core';
+import * as mathLine from '../line';
+
+const DEFAULT_EPSILON = 0.1;
+
+/**
+ * Ramer–Douglas–Peucker algorithm implementation to decimate a polyline
+ * to a similar polyline with fewer points
+ *
+ * https://en.wikipedia.org/wiki/Ramer%E2%80%93Douglas%E2%80%93Peucker_algorithm
+ * https://rosettacode.org/wiki/Ramer-Douglas-Peucker_line_simplification
+ * https://karthaus.nl/rdp/
+ *
+ * @param polyline - Polyline to decimate
+ * @param epsilon - A maximum given distance 'epsilon' to decide if a point
+ * should or shouldn't be added the decimated polyline version. In each
+ * iteration the polyline is split into two polylines and the distance of each
+ * point from those new polylines are checked against the line that connects
+ * the first and last points.
+ * @returns Decimated polyline
+ */
+export default function decimate(
+  polyline: Types.Point2[],
+  epsilon = DEFAULT_EPSILON
+) {
+  const numPoints = polyline.length;
+
+  // The polyline must have at least a start and end points
+  if (numPoints < 3) {
+    return polyline;
+  }
+
+  const epsilonSquared = epsilon * epsilon;
+  const partitionQueue = [[0, numPoints - 1]];
+
+  // Used a boolean array to set each point that will be in the decimated polyline
+  // because pre-allocated arrays are 3-4x faster than thousands of push() calls
+  // to add all points to a new array.
+  const polylinePointFlags = new Array(numPoints).fill(false);
+
+  // Start and end points are always added to the decimated polyline
+  let numDecimatedPoints = 2;
+
+  // Add start and end points to the decimated polyline
+  polylinePointFlags[0] = true;
+  polylinePointFlags[numPoints - 1] = true;
+
+  // Iterative approach using a queue instead of recursion to reduce the number
+  // of function calls (performance)
+  while (partitionQueue.length) {
+    const [startIndex, endIndex] = partitionQueue.pop();
+
+    // Return if there is no point between the start and end points
+    if (endIndex - startIndex === 1) {
+      continue;
+    }
+
+    const startPoint = polyline[startIndex];
+    const endPoint = polyline[endIndex];
+    let maxDistSquared = -Infinity;
+    let maxDistIndex = -1;
+
+    // Search for the furthest point
+    for (let i = startIndex + 1; i < endIndex; i++) {
+      const currentPoint = polyline[i];
+      const distSquared = mathLine.distanceToPointSquared(
+        startPoint,
+        endPoint,
+        currentPoint
+      );
+
+      if (distSquared > maxDistSquared) {
+        maxDistSquared = distSquared;
+        maxDistIndex = i;
+      }
+    }
+
+    // Do not add any of the points because the fursthest one is very close to
+    // the line based on the epsilon value
+    if (maxDistSquared < epsilonSquared) {
+      continue;
+    }
+
+    // Update the flag for the furthest point because it will be added to the
+    // decimated polyline
+    polylinePointFlags[maxDistIndex] = true;
+    numDecimatedPoints++;
+
+    // Partition the points into two parts using maxDistIndex as the pivot point
+    // and process both sides
+    partitionQueue.push([maxDistIndex, endIndex]);
+    partitionQueue.push([startIndex, maxDistIndex]);
+  }
+
+  // A pre-allocated array is 3-4x faster then multiple push() calls
+  const decimatedPolyline: Types.Point2[] = new Array(numDecimatedPoints);
+
+  for (let srcIndex = 0, dstIndex = 0; srcIndex < numPoints; srcIndex++) {
+    if (polylinePointFlags[srcIndex]) {
+      decimatedPolyline[dstIndex++] = polyline[srcIndex];
+    }
+  }
+
+  return decimatedPolyline;
+}
diff --git a/packages/tools/src/utilities/math/polyline/index.ts b/packages/tools/src/utilities/math/polyline/index.ts
index 0608b144e1..7091c4c3c8 100644
--- a/packages/tools/src/utilities/math/polyline/index.ts
+++ b/packages/tools/src/utilities/math/polyline/index.ts
@@ -9,6 +9,7 @@ import getNormal3 from './getNormal3';
 import getNormal2 from './getNormal2';
 import { mergePolylines, subtractPolylines } from './combinePolyline';
 import intersectPolyline from './intersectPolyline';
+import decimate from './decimate';
 import getFirstLineSegmentIntersectionIndexes from './getFirstLineSegmentIntersectionIndexes';
 import getLineSegmentIntersectionsIndexes from './getLineSegmentIntersectionsIndexes';
 import getLineSegmentIntersectionsCoordinates from './getLineSegmentIntersectionsCoordinates';
@@ -30,6 +31,7 @@ export {
   getNormal3,
   getNormal2,
   intersectPolyline,
+  decimate,
   getFirstLineSegmentIntersectionIndexes,
   getLineSegmentIntersectionsIndexes,
   getLineSegmentIntersectionsCoordinates,