diff --git a/src/eventListeners/onImageRenderedBrushEventHandler.js b/src/eventListeners/onImageRenderedBrushEventHandler.js
index 2146edf8c..068f5b5a4 100644
--- a/src/eventListeners/onImageRenderedBrushEventHandler.js
+++ b/src/eventListeners/onImageRenderedBrushEventHandler.js
@@ -139,16 +139,29 @@ function renderSegmentation(evt, segIndex, segData) {
     );
   }
 
-  if (toolData.data[segIndex].invalidated) {
-    createNewBitmapAndQueueRenderOfSegmentation(evt, toolData, segIndex);
-  }
-}
-
-function createNewBitmapAndQueueRenderOfSegmentation(evt, toolData, segIndex) {
   const eventData = evt.detail;
   const element = eventData.element;
   const enabledElement = external.cornerstone.getEnabledElement(element);
 
+  if (
+    toolData.data[segIndex].invalidated ||
+    state.invalidatedEnabledElements.includes(enabledElement.uuid)
+  ) {
+    createNewBitmapAndQueueRenderOfSegmentation(
+      eventData,
+      enabledElement.uuid,
+      toolData,
+      segIndex
+    );
+  }
+}
+
+function createNewBitmapAndQueueRenderOfSegmentation(
+  { image: eventImage, element },
+  enabledElementUID,
+  toolData,
+  segIndex
+) {
   const pixelData = toolData.data[segIndex].pixelData;
   const imageSpecificSegmentationAlpha = toolData.data[segIndex].alpha;
 
@@ -160,10 +173,7 @@ function createNewBitmapAndQueueRenderOfSegmentation(evt, toolData, segIndex) {
   const colormap = external.cornerstone.colors.getColormap(colormapId);
   const colorLutTable = [[0, 0, 0, 0], colormap.getColor(segIndex)];
 
-  const imageData = new ImageData(
-    eventData.image.width,
-    eventData.image.height
-  );
+  const imageData = new ImageData(eventImage.width, eventImage.height);
   const image = {
     stats: {},
     minPixelValue: 0,
@@ -185,13 +195,16 @@ function createNewBitmapAndQueueRenderOfSegmentation(evt, toolData, segIndex) {
 
   window.createImageBitmap(imageData).then(newImageBitmap => {
     setters.imageBitmapCacheForElement(
-      enabledElement.uuid,
+      enabledElementUID,
       segIndex,
       newImageBitmap
     );
     toolData.data[segIndex].invalidated = false;
+    state.invalidatedEnabledElements = state.invalidatedEnabledElements.filter(
+      iee => iee !== enabledElementUID
+    );
 
-    external.cornerstone.updateImage(eventData.element);
+    external.cornerstone.updateImage(element);
   });
 }
 
diff --git a/src/store/modules/brushModule.js b/src/store/modules/brushModule.js
index 90742d244..56e6e8a8b 100644
--- a/src/store/modules/brushModule.js
+++ b/src/store/modules/brushModule.js
@@ -12,6 +12,8 @@ const state = {
   visibleSegmentations: {},
   imageBitmapCache: {},
   segmentationMetadata: {},
+  //
+  invalidatedEnabledElements: [],
 };
 
 const setters = {
@@ -25,6 +27,15 @@ const setters = {
     state.radius = Math.min(Math.max(radius, state.minRadius), state.maxRadius);
   },
 
+  forceUpdateImageForElement(element) {
+    const enabledElement = external.cornerstone.getEnabledElement(element);
+    const enabledElementUID = enabledElement.uuid;
+
+    if (!state.invalidatedEnabledElements.includes(enabledElementUID)) {
+      state.invalidatedEnabledElements.push(enabledElementUID);
+    }
+  },
+
   /**
    * TODO: Should this be a init config property?
    * Sets the brush color map to something other than the default