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.

中文翻译：

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具有软组织变形的实时医学模拟的系统综述：计算方法，交互设备，系统架构和临床验证

模拟软组织的变形是一项复杂的工程任务，当面对计算速度和系统精度之间的约束时，难度甚至更大。然而，文献缺乏对开发有效的软组织模拟系统的所有必要方面（计算方法，交互装置，系统架构和临床验证）的全面审查。本文总结并分析了解决这些问题的最新成就，以估计总体趋势和未来发展的弱点。使用PRISMA协议和三个可靠的科学搜索引擎（ScienceDirect，PubMed和IEEE）进行了系统的审查过程。最终选择了55篇相关论文并将其纳入审查过程，并对它们进行了质量评估。计算方法分为网格，无网格和混合方法。交互设备涉及虚拟手术器械和力反馈设备，3D扫描仪，生物力学传感器，人机接口设备，3D查看器和2D / 3D光学相机之间的组合。基于系统执行方案和系统框架的概念对系统架构进行了分析。特别地，系统执行方案包括基于分发的，基于多线程的和基于多模型的执行。系统框架分为输入和输出交互框架，图形交互框架，建模框架和混合框架。临床验证程序分为三个级别：几何验证，模型行为验证和用户可接受性/安全性验证。本综述文件提供了有用的信息，以表征如何开发具有软组织变形的实时医学模拟系统。通过清楚地分析每个系统开发方面的优缺点，该综述可以用作开发软组织仿真系统的参考指南。