This book constitutes the refereed proceedings of the 5th International Symposium on Biomedical Simulation, ISBMS 2010, held in Phoenix, AZ, USA, in January 2010. The 19 revised full papers were carefully reviewed and selected from 41 submissions. The manuscripts are organized in four thematic sections covering some of the key aspects of biomedical simulation: soft tissue properties, modelling and segmentation, simulation of biophysical processes and real-time interactive simulation.