Brightness modulation (B-Mode) ultrasound (US) images are used to visualize internal body structures during diagnostic and invasive procedures, such as needle insertion for Regional Anesthesia. Due to patient availability and health risks-during invasive procedures-training is often limited, thus, medical training simulators become a viable solution to the problem. Simulation of ultrasound images for medical training requires not only an acceptable level of realism but also interactive rendering times in order to be effective. To address these challenges, we present a generative method for simulating B-Mode ultrasound images using surface representations of the body structures and geometrical acoustics to model sound propagation and its interaction within soft tissue. Furthermore, physical models for backscattered, reflected and transmitted energies as well as for the beam profile are used in order to improve realism. Through the proposed methodology we are able to simulate, in real-time, plausible view- and depth-dependent visual artifacts that are characteristic in B-Mode US images, achieving both, realism and interactivity.