diff --git a/packages/core/src/types/IImageFrame.ts b/packages/core/src/types/IImageFrame.ts
index 22c6a4ff72..7d94d97743 100644
--- a/packages/core/src/types/IImageFrame.ts
+++ b/packages/core/src/types/IImageFrame.ts
@@ -9,6 +9,7 @@ interface ImageFrame {
   columns: number;
   bitsAllocated: number;
   bitsStored: number;
+  highBit?: number;
   pixelRepresentation: number;
   smallestPixelValue: number;
   largestPixelValue: number;
diff --git a/packages/dicomImageLoader/src/__tests__/normalizeStoredPixelData.spec.ts b/packages/dicomImageLoader/src/__tests__/normalizeStoredPixelData.spec.ts
new file mode 100644
index 0000000000..97ce40d337
--- /dev/null
+++ b/packages/dicomImageLoader/src/__tests__/normalizeStoredPixelData.spec.ts
@@ -0,0 +1,59 @@
+import type { Types } from '@cornerstonejs/core';
+import normalizeStoredPixelData from '../shared/normalizeStoredPixelData';
+
+function createImageFrame(
+  pixelData: Types.PixelDataTypedArray,
+  overrides: Partial<Types.IImageFrame> = {}
+): Types.IImageFrame {
+  return {
+    bitsAllocated: 16,
+    bitsStored: 14,
+    highBit: 13,
+    pixelRepresentation: 0,
+    pixelData,
+    ...overrides,
+  } as Types.IImageFrame;
+}
+
+describe('normalizeStoredPixelData', () => {
+  it('removes unused upper bits from unsigned pixels', () => {
+    const imageFrame = createImageFrame(new Uint16Array([32768, 41249, 65343]));
+
+    normalizeStoredPixelData(imageFrame);
+
+    expect(imageFrame.pixelData).toEqual(new Uint16Array([0, 8481, 16191]));
+  });
+
+  it('sign extends signed stored pixels', () => {
+    const imageFrame = createImageFrame(
+      new Int16Array([0x3fff, 0x2000, 0x1fff]),
+      { pixelRepresentation: 1 }
+    );
+
+    normalizeStoredPixelData(imageFrame);
+
+    expect(imageFrame.pixelData).toEqual(new Int16Array([-1, -8192, 8191]));
+  });
+
+  it('uses HighBit to extract a shifted stored field', () => {
+    const imageFrame = createImageFrame(new Uint16Array([0xfff8, 0x4000]), {
+      bitsStored: 12,
+      highBit: 14,
+    });
+
+    normalizeStoredPixelData(imageFrame);
+
+    expect(imageFrame.pixelData).toEqual(new Uint16Array([4095, 2048]));
+  });
+
+  it('leaves pixels unchanged when all allocated bits are stored', () => {
+    const imageFrame = createImageFrame(new Uint16Array([0, 41249, 65535]), {
+      bitsStored: 16,
+      highBit: 15,
+    });
+
+    normalizeStoredPixelData(imageFrame);
+
+    expect(imageFrame.pixelData).toEqual(new Uint16Array([0, 41249, 65535]));
+  });
+});
diff --git a/packages/dicomImageLoader/src/decodeImageFrameWorker.js b/packages/dicomImageLoader/src/decodeImageFrameWorker.js
index 4e84cd6a84..6add190e14 100644
--- a/packages/dicomImageLoader/src/decodeImageFrameWorker.js
+++ b/packages/dicomImageLoader/src/decodeImageFrameWorker.js
@@ -21,6 +21,7 @@ import getPixelDataTypeFromMinMax, {
   validatePixelDataType,
 } from './shared/getPixelDataTypeFromMinMax';
 import isColorImage from './shared/isColorImage';
+import normalizeStoredPixelData from './shared/normalizeStoredPixelData';
 
 const imageUtils = {
   bilinear,
@@ -41,20 +42,7 @@ export function postProcessDecodedPixels(
   start,
   decodeConfig
 ) {
-  const shouldShift =
-    imageFrame.pixelRepresentation !== undefined &&
-    imageFrame.pixelRepresentation === 1;
-
-  const shift =
-    shouldShift && imageFrame.bitsStored !== undefined
-      ? 32 - imageFrame.bitsStored
-      : undefined;
-
-  if (shouldShift && shift !== undefined) {
-    for (let i = 0; i < imageFrame.pixelData.length; i++) {
-      imageFrame.pixelData[i] = (imageFrame.pixelData[i] << shift) >> shift;
-    }
-  }
+  normalizeStoredPixelData(imageFrame);
 
   // Cache the pixelData reference quickly incase we want to set a targetBuffer _and_ scale.
   let pixelDataArray = imageFrame.pixelData;
diff --git a/packages/dicomImageLoader/src/imageLoader/getImageFrame.ts b/packages/dicomImageLoader/src/imageLoader/getImageFrame.ts
index 3c5e3f95f8..5aca9d11f9 100644
--- a/packages/dicomImageLoader/src/imageLoader/getImageFrame.ts
+++ b/packages/dicomImageLoader/src/imageLoader/getImageFrame.ts
@@ -16,6 +16,7 @@ function getImageFrame(imageId: string): Types.IImageFrame {
     columns: imagePixelModule.columns,
     bitsAllocated: imagePixelModule.bitsAllocated,
     bitsStored: imagePixelModule.bitsStored,
+    highBit: imagePixelModule.highBit,
     pixelRepresentation: imagePixelModule.pixelRepresentation, // 0 = unsigned,
     smallestPixelValue: imagePixelModule.smallestPixelValue,
     largestPixelValue: imagePixelModule.largestPixelValue,
diff --git a/packages/dicomImageLoader/src/shared/normalizeStoredPixelData.ts b/packages/dicomImageLoader/src/shared/normalizeStoredPixelData.ts
new file mode 100644
index 0000000000..7ca2ab03f4
--- /dev/null
+++ b/packages/dicomImageLoader/src/shared/normalizeStoredPixelData.ts
@@ -0,0 +1,43 @@
+import type { Types } from '@cornerstonejs/core';
+
+/**
+ * Removes bits outside the stored pixel field and sign extends signed values.
+ */
+export default function normalizeStoredPixelData(
+  imageFrame: Types.IImageFrame
+): void {
+  const {
+    bitsAllocated,
+    bitsStored,
+    highBit = bitsStored - 1,
+    pixelData,
+    pixelRepresentation,
+  } = imageFrame;
+  const lowBit = highBit - bitsStored + 1;
+
+  if (
+    !pixelData ||
+    bitsStored <= 0 ||
+    bitsStored >= 32 ||
+    bitsStored > bitsAllocated ||
+    lowBit < 0 ||
+    highBit >= bitsAllocated ||
+    (bitsStored === bitsAllocated && lowBit === 0)
+  ) {
+    return;
+  }
+
+  const valueRange = 2 ** bitsStored;
+  const mask = valueRange - 1;
+  const signBit = valueRange / 2;
+  const isSigned = pixelRepresentation === 1;
+
+  for (let i = 0; i < pixelData.length; i++) {
+    const storedValue = (pixelData[i] >>> lowBit) & mask;
+    pixelData[i] = storedValue;
+
+    if (isSigned && storedValue >= signBit) {
+      pixelData[i] -= valueRange;
+    }
+  }
+}