diff --git a/packages/tools/src/tools/annotation/RectangleROITool.ts b/packages/tools/src/tools/annotation/RectangleROITool.ts
index a3cfc0c67e..fb63b5f2da 100644
--- a/packages/tools/src/tools/annotation/RectangleROITool.ts
+++ b/packages/tools/src/tools/annotation/RectangleROITool.ts
@@ -53,7 +53,7 @@ import { isViewportPreScaled } from '../../utilities/viewport/isViewportPreScale
 import { BasicStatsCalculator } from '../../utilities/math/basic';
 import { getStyleProperty } from '../../stateManagement/annotation/config/helpers';
 
-const { transformWorldToIndex } = csUtils;
+const { transformWorldToIndex, transformWorldToIndexContinuous } = csUtils;
 
 /**
  * RectangleROIAnnotation let you draw annotations that measures the statistics
@@ -841,11 +841,11 @@ class RectangleROITool extends AnnotationTool {
 
       const { dimensions, imageData, metadata, voxelManager } = image;
 
-      const indexHandles = worldHandles.map((worldHandle) =>
-        transformWorldToIndex(imageData, worldHandle)
+      const continuousIndexHandles = worldHandles.map((worldHandle) =>
+        transformWorldToIndexContinuous(imageData, worldHandle)
       );
-      const pos1Index = indexHandles[0].map(Math.floor);
-      const pos2Index = indexHandles[3].map(Math.floor);
+      const pos1Index = transformWorldToIndex(imageData, worldHandles[0]);
+      const pos2Index = transformWorldToIndex(imageData, worldHandles[3]);
 
       // Check if one of the indexes are inside the volume, this then gives us
       // Some area to do stats over.
@@ -874,12 +874,12 @@ class RectangleROITool extends AnnotationTool {
         const calibrate = getCalibratedLengthUnitsAndScale(image, handles);
 
         const width = RectangleROITool.calculateLengthInIndex(calibrate, [
-          indexHandles[0],
-          indexHandles[1],
+          continuousIndexHandles[0],
+          continuousIndexHandles[1],
         ]);
         const height = RectangleROITool.calculateLengthInIndex(calibrate, [
-          indexHandles[0],
-          indexHandles[2],
+          continuousIndexHandles[0],
+          continuousIndexHandles[2],
         ]);
         const area = Math.abs(width * height);
         const { areaUnit } = calibrate;
diff --git a/packages/tools/src/tools/annotation/UltrasoundDirectionalTool.ts b/packages/tools/src/tools/annotation/UltrasoundDirectionalTool.ts
index 0acb38203b..2832574c3e 100644
--- a/packages/tools/src/tools/annotation/UltrasoundDirectionalTool.ts
+++ b/packages/tools/src/tools/annotation/UltrasoundDirectionalTool.ts
@@ -47,7 +47,7 @@ import type {
 import type { StyleSpecifier } from '../../types/AnnotationStyle';
 import { getCalibratedProbeUnitsAndValue } from '../../utilities/getCalibratedUnits';
 import { lineSegment } from '../../utilities/math';
-const { transformWorldToIndex } = csUtils;
+const { transformWorldToIndexContinuous } = csUtils;
 
 /**
  * The `UltrasoundDirectionalTool` class is a tool for creating directional ultrasound annotations.
@@ -767,8 +767,8 @@ class UltrasoundDirectionalTool extends AnnotationTool {
       const worldPos1 = data.handles.points[0];
       const worldPos2 = data.handles.points[1];
 
-      const imageIndex1 = transformWorldToIndex(imageData, worldPos1);
-      const imageIndex2 = transformWorldToIndex(imageData, worldPos2);
+      const imageIndex1 = transformWorldToIndexContinuous(imageData, worldPos1);
+      const imageIndex2 = transformWorldToIndexContinuous(imageData, worldPos2);
 
       const { values: values1, units: units1 } =
         getCalibratedProbeUnitsAndValue(image, [imageIndex1]);
diff --git a/packages/tools/test/RectangleROIArea.jest.js b/packages/tools/test/RectangleROIArea.jest.js
new file mode 100644
index 0000000000..4e7dbe9d70
--- /dev/null
+++ b/packages/tools/test/RectangleROIArea.jest.js
@@ -0,0 +1,63 @@
+import RectangleROITool from '../src/tools/annotation/RectangleROITool';
+
+describe('Rectangle ROI area', () => {
+  it('uses continuous indices for physical area', () => {
+    const tool = new RectangleROITool();
+    const targetId = 'imageId:test';
+    const forEach = jest.fn();
+    const image = {
+      dimensions: [100, 100, 1],
+      hasPixelSpacing: true,
+      imageData: {
+        worldToIndex: ([x, y, z]) => [x / 5, y / 5, z],
+      },
+      metadata: { Modality: 'CT' },
+      spacing: [5, 5, 1],
+      voxelManager: { forEach },
+    };
+    const annotation = {
+      data: {
+        cachedStats: { [targetId]: {} },
+        handles: {
+          points: [
+            [2, 2, 0],
+            [29, 2, 0],
+            [2, 18, 0],
+            [29, 18, 0],
+          ],
+        },
+      },
+      invalidated: false,
+      metadata: {},
+    };
+    const viewport = {
+      element: document.createElement('div'),
+    };
+
+    tool.getTargetImageData = () => image;
+    tool.configuration.statsCalculator = {
+      getStatistics: () => ({ array: [] }),
+      statsCallback: jest.fn(),
+    };
+
+    tool._calculateCachedStats(
+      annotation,
+      [0, 0, 1],
+      [0, 1, 0],
+      {},
+      { viewport }
+    );
+
+    expect(annotation.data.cachedStats[targetId].area).toBeCloseTo(27 * 16);
+    expect(forEach).toHaveBeenCalledWith(
+      tool.configuration.statsCalculator.statsCallback,
+      expect.objectContaining({
+        boundsIJK: [
+          [0, 6],
+          [0, 4],
+          [0, 0],
+        ],
+      })
+    );
+  });
+});
diff --git a/packages/tools/test/UltrasoundDirectionalTool.jest.js b/packages/tools/test/UltrasoundDirectionalTool.jest.js
new file mode 100644
index 0000000000..5205313724
--- /dev/null
+++ b/packages/tools/test/UltrasoundDirectionalTool.jest.js
@@ -0,0 +1,59 @@
+import UltrasoundDirectionalTool from '../src/tools/annotation/UltrasoundDirectionalTool';
+
+describe('Ultrasound Directional measurements', () => {
+  it('uses continuous indices for calibrated endpoint values', () => {
+    const tool = new UltrasoundDirectionalTool();
+    const targetId = 'imageId:test';
+    const image = {
+      calibration: {
+        sequenceOfUltrasoundRegions: [
+          {
+            regionDataType: 1,
+            regionLocationMinX0: 0,
+            regionLocationMaxX1: 100,
+            regionLocationMinY0: 0,
+            regionLocationMaxY1: 100,
+            physicalUnitsXDirection: 4,
+            physicalUnitsYDirection: 7,
+            physicalDeltaX: 2,
+            physicalDeltaY: 3,
+          },
+        ],
+      },
+      imageData: {
+        worldToIndex: ([x, y, z]) => [x, y, z],
+      },
+    };
+    const annotation = {
+      data: {
+        cachedStats: { [targetId]: {} },
+        handles: {
+          points: [
+            [0.2, 0.3, 0],
+            [10.7, 4.8, 0],
+          ],
+        },
+      },
+      invalidated: false,
+    };
+    const viewport = {
+      element: document.createElement('div'),
+      worldToCanvas: ([x, y]) => [x, y],
+    };
+
+    tool.getTargetImageData = () => image;
+
+    tool._calculateCachedStats(annotation, {}, { viewport });
+
+    const { xValues, yValues, isHorizontal, units, isUnitless } =
+      annotation.data.cachedStats[targetId];
+
+    expect(xValues[0]).toBeCloseTo(0.4);
+    expect(xValues[1]).toBeCloseTo(21.4);
+    expect(yValues[0]).toBeCloseTo(0.9);
+    expect(yValues[1]).toBeCloseTo(14.4);
+    expect(isHorizontal).toBe(true);
+    expect(units).toEqual(['seconds', 'cm/sec']);
+    expect(isUnitless).toBe(false);
+  });
+});