A Systematic Review of Real-Time Medical Simulations with Soft-Tissue Deformation: Computational Approaches, Interaction Devices, System Architectures, and Clinical Validations

Abstract

Simulating deformations of soft tissues is a complex engineering task, and it is even more difficult when facing the constraint between computation speed and system accuracy. However, literature lacks of a holistic review of all necessary aspects (computational approaches, interaction devices, system architectures, and clinical validations) for developing an effective system of soft-tissue simulations. This paper summarizes and analyses recent achievements of resolving these issues to estimate general trends and weakness for future developments. A systematic review process was conducted using the PRISMA protocol with three reliable scientific search engines (ScienceDirect, PubMed, and IEEE). Fifty-five relevant papers were finally selected and included into the review process, and a quality assessment procedure was also performed on them. The computational approaches were categorized into mesh, meshfree, and hybrid approaches. The interaction devices concerned about combination between virtual surgical instruments and force-feedback devices, 3D scanners, biomechanical sensors, human interface devices, 3D viewers, and 2D/3D optical cameras. System architectures were analysed based on the concepts of system execution schemes and system frameworks. In particular, system execution schemes included distribution-based, multithread-based, and multimodel-based executions. System frameworks are grouped into the input and output interaction frameworks, the graphic interaction frameworks, the modelling frameworks, and the hybrid frameworks. Clinical validation procedures are ordered as three levels: geometrical validation, model behavior validation, and user acceptability/safety validation. The present review paper provides useful information to characterize how real-time medical simulation systems with soft-tissue deformations have been developed. By clearly analysing advantages and drawbacks in each system development aspect, this review can be used as a reference guideline for developing systems of soft-tissue simulations.

Control of Haptic Systems Based on Input-to-State Stability

“…𝐹𝐹 𝑒𝑒 (𝑛𝑛) turns into analog signal 𝐹𝐹 𝑟𝑟 (𝑡𝑡) = 𝐹𝐹 𝑒𝑒 (𝑛𝑛)𝑍𝑍𝑍𝑍𝐻𝐻 which is the force rendered to the operator. Physics-based simulations involving deformable objects have slow force update rates of 300 Hz to 500 Hz due to large amounts of computation [3]. Sampling time 𝑇𝑇 is assumed to be 2 ms in this paper for the sake of analysis, which is considered typical and plausible in haptic systems.…”

“…The sampler and ZOH is given in [27]. The 𝑒𝑒 −𝑑𝑑𝑠𝑠 is replaced with Taylor series as in (3). It is known that the human operator applies a position input of up to 20 Hz in typical haptic rendering [7].…”

“…The discretization effect becomes worse as stiffness of the virtual environment and sampling time increase. Physics-based simulations involving deformable objects have a slow force update rates of 300 Hz to 500 Hz due to large amounts of computation [3], which increases the active behavior of the haptic systems. It is important to enhance transparency while maintaining stability in systems that require high-fidelity haptic feedback, such as medical simulations.…”

Soft Tissue Hybrid Model for Real-Time Simulations

“…The articles of Delingette et al [ 15 ], Picinbono et al [ 16 ], Holzapfel et al [ 17 ], Ostaja-Starzewski [ 18 ], Meier et al [ 19 ], Nealen et al [ 20 ], Luo and Xiao [ 21 ], Tang et al [ 22 ], Liu et al [ 23 ], San Vicente et al [ 24 ], Del Castillo et al [ 25 ], Nikolaev [ 26 ], Kot et al [ 27 ], Lloyd et al [ 28 , 29 ], Omar and Zhong [ 30 , 31 ], Nguyen et al [ 32 ], Zhang et al [ 33 ], Dong et al [ 34 ], Va et al [ 35 ], Aryeetey et al [ 36 ], Tripicchio et al [ 37 ], Ballit and Dao [ 38 ], and references cited therein, have good discussions on how to incorporate typical biological properties and behavior of soft tissue, and how to perform a correct mapping of the elastic properties among physical objects and the SMM elements. All these related works attempt to simulate soft tissue deformation for surgical real-time visual and force haptic interaction.…”

A Meshfree Method for Deformation Field Reconstruction of Soft Tissue in Needle Insertion

“…Biomechanical modeling provides a sensorless way to reconstruct the deformation field of soft tissues. The FE and meshfree methods are two streams that have been currently used in the soft tissue deformation simulation [6]. The former is most frequently be applied in infinitesimal deformations problems.…”