OCTOBER 2009 / 115

DOI 10.1007/s12541-009-0079-z

Efficient Soft Tissue Characterization under
Large Deformations in Medical Simulations
Bummo Ahn1 and Jung Kim1,#
1 School of Mechanical, Aerospace & Systems Engineering, Department of Mechanical Engineering, KAIST, Daejeon, South Korea, 305-701
# Corresponding Author / E-mail:, TEL: +82-42-350-3231, FAX: +82-42-350-5230
KEYWORDS: Indentation experiment, Large deformation, Medical simulation, Soft tissue characterization

The modeling of soft tissue behavior is essential for virtual reality (VR)-based medical simulation, providing a safe
and objective medium for training of the medical personnel. This paper presents a soft tissue modeling framework
including instrumentation design, in vitro organ experiments and material property characterization. As observed
from the force responses measured by a force transducer, the tissue was assumed as a nonlinear, continuous,
incompressible, homogeneous and isotropic material for modeling. An electromechanical indentation system to
measure the mechanical behavior of soft tissues was designed, and a series harvested organ in vitro experiments
were performed. The non-linear soft tissue model parameters were then extracted by matching finite element
model predictions with the empirical data. The soft tissue characterization algorithm could become
computationally efficient by reducing the number of parameters. The developed tissue models are suitable for
computing accurate reaction forces on surgical instruments and for computing deformations of organ surfaces for
the VR based medical simulation.
Manuscript received: September 22, 2008 / Accepted: June 22, 2009

S(t) = Piola-Kirchhoff stress tensor
G(t) = Reduced relaxation function
E(λ) = Strain tensor
Se(E(λ)) = Material’s pure elastic response
τi = Reduced relaxation time constant
W = Strain energy function
C10 = Mechanical parameter having a unit of stress
I1 = Principal invariant
ki = Rigidity modulus
R2 = Coefficient of determination
Fe, = Measured force
Fs, = Simulated force
Λ = Marquardt parameter

1. Introduction
Conventional surgical procedures have been replaced with
minimally invasive surgery (MIS) for many abdominal operations.
Surgeons need to train using the surgical techniques due to complex
© KSPE and Springer 2009

eye hand coordination, restricted field of view, and poor tactile
sensation.1 Therefore, much time and effort are required for
surgeons to become competent in performing MIS. Since surgeons
have traditionally acquired medical skills through the practice on
living animals, cadavers, and even patients, such processes
inevitably involve animal sacrifices and ethical controversies.
Alternatively, virtual reality (VR)-based medical simulations2,3
provide a realistic environment, as in surgical operations for
training surgeons, and thus a means by which surgeons can acquire
various medical skills in safe and ethical conditions. Medical
simulations enable novice surgeons to indirectly acquire
competency in complicated surgical skills that are otherwise risky
and difficult to learn through surgery on patients. These simulations
require accurate organ geometry, fast computation algorithms, and
the mechanical properties of the soft tissue. Although high fidelity
organ geometry and fast computation algorithms to simulate tissue
deformation have been investigated,4,5 the characterization of
mechanical properties has not yet been sufficiently studied due to
the difficulties in testing and modeling the complexities of time
dependency and nonlinearity of soft tissue.
Many researchers have, therefore, investigated the mechanical

Materials and Methods 2. relaxation. anisotropic. used for the FEM simulation with the algorithm. and the maximum speed was 8 mm/s. Fall River. Ltd. 2 Force response of the porcine liver (relaxation) δz Fig. Then the force responses were measured with force transducer and recorded with the data acquisition system (Ace Kit 1103 PX4 CLP. researchers have performed tissue experiments using indentation. were updated iteratively by minimizing the errors between the FE model predictions and the experimental responses. The indentation zone of the porcine liver was the center area of the median lobe for consistency in the experimental results. 2. No. then. It is well known that soft tissues exhibit complex nonlinear. 4 found by calibrating the dynamic motion of the motor. 22. The displacement range was up to 41.6 To measure the mechanical responses.8 kN.23 In addition. porcine liver is readily available. they were characterized automatically until the simulated and experimental responses matched.5 mm displacements. The onedimensional indentation device is composed of a force transducer (Senstech Co. MA. It can also be seen that the mechanical properties obtained from the literature show large variations according to the measurement and characterization methods.1 Experimental setup Figure 1 shows the experimental setup used to record the forcetime-displacement data from the tissue response. The raw data of the force responses. soft tissue experiments were performed on porcine livers under large deformations using the hemisphere tip indenter.2 Soft tissue experiments Investigation of liver biomechanics can provide useful information such as clinical knowledge and safe provision against various injuries. We preserved them in an icebox and delivered to the laboratory within a few hours of extraction to avoid dehydration.15 shear strain. 3 Deformation of the elastic and semi-infinite body with a rigid hemisphere indenter Fig. uniform deformation and friction free contact were assumed in order to permit the sliding of the tissue across the surface of the indenter. time. The force transducer's resolution was 1 mN and its measurement range was from 1 mN to 9. Korea). and induced 7 mm ramp-and-hold input at the maximum speed.19-21 They estimated the mechanical properties of soft tissues using the empirical data.14. and saw tooth wave inputs of 10 µm ~ 41.7-13 aspiration. are shown in Fig. The parameters. INTERNATIONAL JOURNAL OF PRECISION ENGINEERING AND MANUFACTURING Vol. we decreased the computational time by reducing the number of target parameters. In this research. 2. and velocity dependent behavior. Moreover. and an indenter (hemisphere tip and cylindrical body with 4 mm diameter). relatively inexpensive. nonhomogeneous. The indenter was brought into contact with the sample surface.16-18 and compressive pressure. the assumed semi-infinite elastic body.5 mm. the indenter was removed from the tissue surface and repositioned to proceed with the next experiment. the research on large deformations has been insufficient due to the complex experiments and nonlinear properties of the soft tissue. USA). Experiments were conducted on five subjects by using the indentation device. to characterize the parameters of the tissue model efficiently. 2. sinusoidal. We developed the finite element (FE) model of soft tissues as a physical continuum model. a DC motor (Maxon Precision Motors.116 / OCTOBER 2009 properties of soft tissues to develop realistic models. Germany). the Hertz- .. and estimated that using the Levenberg-Marquardt optimization algorithm combined with an inverse FEM characterization. The maximum position error was less than 5 µm and was Fig. and generally robust for surgical models. rectangular. Porcine liver was selected as a target organ because of its similarity in structure and function to the human liver. The device can induce unit step. 1 Indentation experiment setup For normal indentation.. At the end of the experiments. Although there have been several studies undertaken regarding the measurement and modeling of the quantitative responses of soft tissues. If the indenter contacted perfectly with the tissue.. Fresh porcine livers were obtained from a local abattoir. 10. D-Space Inc.

The algorithm uses the FEM simulation iteratively to find the parameters fitted to the experimental results.1 ± 106. The three dimensional constitutive relationship in the QLV framework is given by: t S (t ) = G (t ) S e (0) + ∫ G (t − τ ) 0 ∂S e ( E (λ )) dτ ∂τ OCTOBER 2009 / 117 W = C10 ( I1 − 3) (4) where C10 is a hyperelastic model parameter with a unit of stress. The reduced relaxation function. The first step estimated the viscoelastic parameters from the normalized force response under the ramp-andhold indentation. G(t). Poisson’s ratio υ was 0. 2. the computational time of this method is expensive. From the force-time data of the tissue for the 7 mm indentation depths. Se(E(λ)) is termed the material’s pure elastic response. The three-dimensional incompressible neo-Hookean model. reaction force. the inverse FEM optimization algorithm has been applied. No. 4 Sneddon equation24-27 (Eq. should be described using nonlinear elasticity theory. This theory assumes that the mechanical behavior can be decoupled into two parts: a linear viscoelastic stress-relaxation response and a time-independent elastic response. was selected for use in this study. For this reason. and each FEM simulation requires one or two hours per run. indenter radius. is a scalar function of time and can often be expressed using the Prony series: N P t G (t ) = G0 (1 − ∑ g i (1 − exp( − ))) τi i =1 G (0) = G0 (3) P where g i and τi are the Prony series’ parameters and reduced relaxation time constants respectively. Richard et al.29-31 was applied for tissue modeling in this study. For the time-independent elastic response. Ideally.28 The tissue behavior under large strains. The second order standard linear solid model is G (t ) = k + k e − 0 1 t / τ1 + k e− 2 t /τ2 (5) . in this study. respectively. The characterization procedures are illustrated in Fig.3. The entire characterization process for all parameters takes several iterations to converge. and indentation depth. W is defined with only the parameters that are required to make an FE model.3 Material models Most medical procedures induce large deformations by instruments. The quasilinear viscoelastic (QLV) framework proposed by Fung. Usually. (2) where S(t) is the Piola-Kirchhoff stress tensor and G(t) is the reduced relaxation function. To characterize the properties of tissues efficiently. λ is the stretch ratio and E(λ) is the strain tensor.33 validated the estimation of the parameters separately and showed that the stress relaxation response can be determined without regard to the particular form of the constitutive law. E= 3 (1 − v 2 ) ⋅ f z ⋅ 4 R ⋅ δ z3 (1) where E. USA). 4. its parameters can be determined by the strain energy function (W). While Kauer et al. the present study estimated the parameters in the viscoelastic model directly from the normalized force-time data in the experiments using the nonlinear least square method in MATLAB (MathWorks. which is widely used in soft tissue simulations. fz. respectively.6 which has been successfully applied to a variety of tissue types. the estimated Young’s modulus was about 1260.4 Pa (average ± standard deviation). and δz are the Young’s modulus. the hyperelastic material model was selected. therefore.1 Estimation of the viscoelastic model parameters A three-dimensional viscoelastic model of the liver was developed from the force-time experimental data.14 used the estimation with the separation of parameters they used the fixed stress relaxation’s time constants and then estimated the other parameters using an inverse FEM optimization algorithm.499. Since the target parameters are only hyperelastic model parameters. but the force reflection and deformation of the simulations are currently used the linear elastic models under small deformations. the initial hyperelastic parameters were estimated from the Young’s modulus to use the Inverse FEM optimization algorithm. Although the Hertz-Sneddon equation is valid for small deformations. 3). The strain energy function of the neo-Hookean model is given by32: Fig. To take the complex boundary and contact conditions between the tool and tissue into account. 4 Flow chart for the Inverse FEM optimization algorithm 2. the computational time was decreased by reducing the number of target parameters. Therefore. and I1 is a principal invariant. Since the tissue was assumed to be an incompressible material. These behaviors are determined separately from the experiments. The stress is linearly superposed with respect to time. the characterization process was separated into two steps instead of estimating all required material parameters in a single step.INTERNATIONAL JOURNAL OF PRECISION ENGINEERING AND MANUFACTURING Vol. was applied to estimate the approximate Young’s modulus of the tissue from the experimental results. Using the parameters obtained in the first step. R. the inverse FEM optimization algorithm was used to determine the hyperelastic parameters. (1) and Fig. 10.

tm ) where Fe. the initial hyperelastic parameters were estimated for 7 mm (210. hence it automatically repeats until the algorithm finds the parameters that match the simulated and experimental forces to an acceptable degree. known as the Levenberg-Marquardt optimization algorithm.03 0. Among several optimization algorithms that could be used. s ] ∂p ∂p  i+   p = p i + H − [ J T ⋅ ( f e − f s ( p i ))] The viscoelastic model parameters were estimated from the normalized force-time profiles in the experiments. The algorithm updates the parameters iteratively depending on the norm of JTJ and the Marquardt parameter. we assumed that the indenter as a rigid body.18 ± 0. isotropic. which is a built-in script for nonlinear curve fitting in MATLAB. and total number of data.5. regular axisymmetric elements (CAX4) were used to develop the FE model. (i = 1. 10. From the estimated Young’s modulus.24 Since deformations were induced in the organ under an axisymmetric condition. With this approach.67 ± 1. 5 Convergence of the hyperelastic model parameters .001 Fig.0 ± 48. Using these initial values. and incompressible solid.02 2 ( ) 1 ( ) Here. and given time. the Jacobian vector J should be computed numerically with respect to each parameter variation. homogeneous. τi. Then.0 (Altair. it is possible to approach the coefficient of determination (R2) to one given by: R2 = 1 − m ∑i= 1 ( Fs (ti ) − Fe (ti )) 2 ( Fe (ti )) 2 (8) ti = (ti .m.3. 2) k0 + k1 + k2 (7) From the above equation and experimental data. respectively.08 21. simulated forces. and coefficient of determinant for each experimental data # of iterations 2 Initial C10(Pa) 210. Because the indenter was much stiffer than the liver. the target Table 2 Viscoelastic model parameters from the normalized experimental data ( ) 1 ( 1) (9) τ1 (sec) τ2 (sec) g1P g 2P 1. time. The program is synchronized with the FEM simulation. Results 2. 4 where ki. G (t ) = G (1 − g P (1 − e − t τ1 ) + g P (1 − e − t / 0 1 = k + k e−t 0 1 /τ 2 2 / τ1 + k e−t )) /τ2 (6) 2 From conditions of G(t = 0) and G(t = ∞). reduced relaxation time constant. and m are measured forces. This approach allows the rigidity modulus to be expressed as a Prony series expansion in the time domain in Eq. it generates new input files using the updated parameters and starts a new simulation. Fs. the program reads the output files and computes the next parameter set using the Levenberg-Marquardt optimization algorithm. respectively. . the center of the liver was limited in the X axis for analysis as in the axisymmetric condition. the nonlinear least square optimization.2 R2 0.24 ± 0.55 0. Hence. the optimization algorithm was used to iterate the FE modeling and automatically update the parameters. Table 3 Initial and estimated parameters for the neo-Hookean model. 5. λ. H = ( J T J + ΛI ) i ∂F ∂F J = [ s . the Prony series parameters are obtained as: g iP = ki . This requires perturbing one parameter running the entire FEM simulation and measuring the perturbation’s effect.40 ± 0. In addition. and t are the rigidity modulus. The FE tissue model was assumed to be a continuous. The computed parameters were input into the ABAQUS database to estimate the nonlinear hyperelastic model parameters. The details of the model are shown in Table 1.2 Estimation of the hyperelastic model parameters The optimization algorithm compares the simulated forces of the FEM simulation with the experimental forces. respectively. t2 . ti. The model was built in Altair HyperMesh 7. 3. The parameters reached convergence in two iterations.2 Pa). The bottom of the liver was constrained in the X and Y directions. After completing the first simulation.34 was adopted. giP and τi can be determined using lsqnonlin. No. (3).996 ± 0. as shown in Fig.2 Estimated C10(Pa) 416. Table 1 Information of FE model # elements 15608 # nodes 16438 Radius 100 mm Thickness 100 mm The inverse FEM optimization algorithm was implemented in the MATLAB script.1 (SIMULIA. H and J are the Hessian and Jacobian vectors of the estimated parameters for the corresponding iteration (i). USA) and simulated with ABAQUS/Standard 6. Table 2 lists the organ’s viscoelastic model parameters which are Prony series parameters and reduced relaxation time constants.118 / OCTOBER 2009 INTERNATIONAL JOURNAL OF PRECISION ENGINEERING AND MANUFACTURING Vol. USA). Since the parameters are contained implicitly in the FEM simulation.

It is difficult to compare our results directly with other results in the literature due to the differences in the experimental methods. the Young’s modulus is estimated to be approximately 2. Although the experimental results by Tay et al. In addition.9 kPa). moreover. species. With these limitations. Therefore. it can be applied to the simulations to estimate the interaction forces and visual deformations displayed in real time. While Kim et al.8 kPa using Eq. the estimated module is different at 13 kPa. devices. and 50 seconds after inducing the indentation. Novel visual and haptic rendering techniques should also be developed.13-15 however.12 are similar to those presented here. this approach may be extended to increasingly complex organs by building layered organ models and estimating each layer’s material properties. The parameters of the viscoelastic model were obtained using the least square method in MATLAB. captured at 1. Other research groups have used all model parameters to characterize the mechanical properties of soft tissues and spent much time to estimate the mechanical properties. This algorithm can be extended easily to include more general features of soft tissue behavior. 10. The results obtained from the optimization algorithm are reliable according to the coefficient of determinant. 10. which was approximately 0.0 ± 48. direct comparisons are not straightforward. OCTOBER 2009 / 119 4. 4 parameters and computational times could be reduced compared with other research results. and loading conditions.99. the model used in this paper was divided into a viscoelastic model and a hyperelastic model. the stress and deformation contours of the model’s inner structure and the simulation converged precisely. surgeons feel that soft tissue is a nonhomogeneous and anisotropic material since soft tissue has complex topologies and anatomical structures. and deformation contour on 7 mm indentation (10) In real operations.2 ~ 2. Second. Figure 6 shows the stress and deformation contours of the developed FE model. . ACKNOWLEDGEMENT Fig. Korea. the simulation results show the stress relaxation according to the time. 7 Force responses of the experiment and simulation This research was supported by the MKE (The Ministry of Knowledge Economy). No. Figure 7 shows the predicted forces from the FEM simulation with the estimated parameters and experimental results. it is important to develop more accurate tissue models that can display more exact force and visual feedback for induced mechanical loads or deformations. Our results obtained using the inverse FEM optimization algorithm are 416 ± 48 Pa (7 mm indentation) of the QLV model parameter. E = 4 ⋅ C10 (1 + v ) Fig. From this method.INTERNATIONAL JOURNAL OF PRECISION ENGINEERING AND MANUFACTURING Vol. and then those of the hyperelastic model were estimated by using the inverse FE model parameter optimization algorithm. In this figure. and 100 seconds. the estimation time could be considerably reduced. the model developed in this study can be used for VR-based medical simulations. this model can be used as a standard to evaluate real-time algorithms for estimating deformations. First.13-15 Table 3 presents the average C10 values of the porcine liver as 416. 10. (10).2 Pa.11 qualitatively support our results (E is approximately 2. From the results. under the ITRC (Information Technology Research Center) support program supervised by the IITA (Institute for Information Technology Advancement) (IITA2009-C1090-0902-0008). 6 FEM simulation of the tissue model in ABAQUS: Stress contour at 1. Discussion This paper shows the soft tissue modeling and efficient characterization method of soft tissue mechanical properties for medical simulations. The force responses of the hyperelastic model and experimental data are almost identical to the value of the determination of coefficient (R2) in Table 3.

pp. K. and Laurendeau...” Medical Image Analysis. 15. Vol. 16.. “Characterization of Viscoelastic Soft Tissue Properties from In vivo Animal Experiments and Inverse FE Parameter Estimation. M. Vol..... Delingette. 285.. 3750. P.. 20..” Springer-Verlag. 12. Rosen. M.. 1-2. Gross. 180-192. H... 5. 12. N. J. V. S. and Srinivasan. D.120 / OCTOBER 2009 REFERENCES 1. Vol. Vol. 57-66.” Rheolgica Acta. T. and Son. No. Nishimura. 6. 021020. pp. 3. 7. 2002. H. Sinanan.. K. A. 3.. Tendick... 1. “Dynamic measurement of soft tissue viscoelastic properties with a torsional resonator device. and Bajka. Vol. 2006. “Relationship between Stiffness of Restorative Material and Stress Distribution for Notch-shaped Non-carious Cervical Lesions. 11. J. 11. 203-216. Kobayashi. C. “A Virtual Environment Testbed for Training Laparoscopic Surgical Skills. 55-58. pp. Kerdok. C. H. G. Downes.. 361-373.. 3. X. Samur. Furrer. “Contact mechanics.” Medical Image Analysis. Y... pp.. 2001. B. W. S. M. 2003.. 9. Ottensmeyer. 41. P. G.. 11.” IEEE Transactions on Visualization and Computer Graphics. Ho. Goktekin. K. K. Nava. INTERNATIONAL JOURNAL OF PRECISION ENGINEERING AND MANUFACTURING Vol. 3. P.” Medical Image Analysis. D. “Minimally invasive and robotic surgery. Szekely. 599-606. N. pp. 3078. No. No. K. E. pp. Buess. 2003. 8. Moisan. H. Cavusoglu. A. Villiger. 1999. Vol. Rancourt.. A. 3. pp. H. “The relation between load and penetration in the axisymmetric boussinesq problem for a punch of arbitrary . Eyal.” Lecture Notes Computer Science. Vol. 53... “In vitro Measurement of Mechanical Properties of Liver Tissue under Compression and Elongation Using a New Test Piece Holding Method with Surgical Glue.” Journal of American Medical Association. 9. 3. 231-236. M. pp. “Continuum Mechanics: Elasticity. 10.. “In vivo mechanical characterization of human liver.” Medical Image Analysis. K. 2129-2138. Avtan.. 2001.. 4.” Lecture Notes Computer Science. “Characterization of Soft-Tissue Material Properties: Large Deformation Analysis. 2006. B. M. Vol. Basdogan. D. pp. S. 19. Basdogan.. “Biomechanics Mechanical Properties of Soft Tissues: second edition. 2008. pp.. No. Davies. 2. T.” IJPEM.” Proceeding of Medicine Meets Virtual Reality.. and Ayache. Bae. and Srinivasan. De. 21. L. 9.. Vol.. Vol. 269-285. pp. pp.” Medical Image Analysis. J. D. M. Vol. Vol.” IEEE Transactions on Biomedical Engineering. No. 23. 2008. R. and Srinivasan.. C. No. L.” Presence-Teleoperators and Virtual Environments. Kim. and Way. Kim. Feygin. and Cotin. 1369-1376. D. Dill. Chen. 2007. 17. 2001. 18. D.. “Inverse Finite Element Characterization of Soft Tissue. Johnson. “Mechanical properties of brain tissue in vivo: experiment and computer simulation. No. T.” CRC Press. Nasseri. R. Valtorta. pp. 10. C.. pp.” IJPEM..17. M. M. 2008.” Journal of Biomechanical Engineering. No. Plasticity. M.. 481-490. Vuskovic. and Reinhart.. 1985. and Cuschieri. X. Kalanovic.. and Dawson. Carter. pp. “Independent testing of soft tissue viscoelasticity using indentation and rotary shear deformations. S. D. J. 2004. 4. O. Frank.. 4. Cotin. No. “Viscoelastic properties of pig kidney in shear. 2. 4 13.. Howe.. D. A.... pp. “Biomechanical Properties of Abdominal Organs in vivo and Postmortem under Compression Loads. 64-67. D.. P. 2. K.” Lecture Notes Computer Science. M. 25.. and Phan-Thien. 9. 6. 9. No. Vol.. 5. J..” Medical Image Analysis. 2000. M. Vol. 2673. L. “The Effects of Testing Environment on the Viscoelastic Properties of Soft Tissues. No. Fung. J. Vol. 1996. Mazza. Vol. Mack. J. Ottensmeyer. P.. Brown. Nielsen.. 15. Wu. J. and Duzgun. “Measurements and Modeling of the Compliance of Human and Porcine Organs. “In vivo mechanical behavior of intra-abdominal organs. Vol. 2000. 568-572. 6.” Computer Graphics Forum. Miller. Lee. I. T. 2005.. No. 236-255. “Real Time Elastic Deformations of Soft Tissues for Surgery Simulation. J. N. I. “Real-time Volumetric Deformable Models for Surgery Simulation using Finite Elements and Condensation. Baik. N.. “Hydroforming Simulation of Highstrength Steel Cross-members in an Automotive Rear Subframe. C. S. M. G. 2. E.” Journal of Biomechanics. 2008. W. No... 24. E. Kim. Viscoelasticity. 5. L. “Virtual environments for medical training: Graphical and haptic simulation of laparoscopic common bile duct exploration.. Vol. C. Hegarty. S. pp. and Hannaford. F. and Mazza. L. pp. Tay.” Cambridge University Press.. 22. H.. “A robotic indenter for minimally invasive measurement and characterization of soft tissue response. 5. J. No. M. pp. and Dawson. and Bednarz. H. 26. Orssengo. F. 62-73. Chinzei. J. Hu.” IEEE-ASME Transactions on Mechatronics. M. C.1021020. Vol. and Desai. 2005. M. pp. T. 284-292.” Lecture Notes Computer Science... E. Bilston. 9. P. Kim. 11. A. Dual. 103-112. S. Chui.. M. S. Inada. 275-287. C. W. and Hisada. 130. 2005.. Denninger. J. E. Mclean. Sneddon. K. Y. No. H. experimental results and modeling. K. K. Kauer.. No. Sedef. Kim. Vol. No. L. 2003. 11. E.. Schwartz. 14. pp.. A. and Won.. Y. Y. G. 28-37. 1996. 9-18. J. M. Sakuma.. “Modelling liver tissue properties using a nonlinear visco-elastic model for surgery simulation. Vol. 3. No. Vol. Park. 33. 2002. Sung. 3078. 5.. E... B.

J. A. D. L. Teukolsky. 330-339. 121. 1. Zheng.. “Viscoelastic characterization of mesenchymal gap tissue and consequences for tension accumulation during distraction. A. P. pp. K. 723-731. Carew. G. E. O. 1996. Vol.. 1992. E. and Goldstein.. Vol. M.” IEEE-ASME.” Cambridge University Press. S. the art of scientific computing: second edition.” IEEE-ASME. “Constitutive models of rubber elasticity: A review. pp. Silke. 30. S.. W. Journal of Biomechanical Engineering. Vol. E. Livesay. 3.” Proceeding of World Haptics. 124. S. 386-392. “Mechanical properties of single living cells encapsulated in polyelectrolyte matrixes. A. Tiziana.. 1999.. Richards.. 118. 504-523.” International Journal of Engineering and Science. Ranieri. 2000.. and Arruda. 2.. “Extraction of Quasi-Linear Viscoelastic Parameters for Lower Limb Soft Tissues from Manual Indentation Experiments. Press. 33. pp.” Rubber Chemistry and Technology. pp. M. 28. “Quasi-linear viscoelastic theory applied to internal shearing of porcine aortic valve leaflets. G. H. pp. 47-57. G. P.. and Rajagopal. F. Wineman. Boughner. I. 29. 221-226.. A. Vol. “Force Feedback is Noticeably Different for Linear versus Nonlinear Elastic Tissue Models. Ornella. Talman. Vol. Misra. T. and Ramesh. 1. pp.. 519524. “Numerical recipes in C++. 4.” Journal of Biomechanical Engineering. W. 27.. No. and Vesely. Vetterling. No. K... 4. 1999. and Mark. No. pp. 116-123. 34. E. Alsberg.. S. 1. and Flannery. Woo. 1999. S. 3. 2007.” Journal of Biomechanical Engineering. No.” Journal of Biotechnology.. R. C. 121. Boyce. 4 profile. 31. A. 73. No.. Vol. A. M. and Alessandra. Vol. R. Y.INTERNATIONAL JOURNAL OF PRECISION ENGINEERING AND MANUFACTURING Vol. S. R. L. 3. Y. T. M. 1965. No. Journal of Biomechanical Engineering. 121. pp.. 10. B. A. OCTOBER 2009 / 121 .. Johnson. Goulet. K. A. “A single integral finite strain viscoelastic model of ligaments and tendons. Vol. C. No. A. T. 32. Okamura. No. 2006..