Education of healthcare professionals is of primary importance for patient safety. In some health related professions, education and training have to be practiced during the entire working period and not only limited to school years. The use of new technology such as virtual reality and e-learning brings new possibilities with significant improvement in learning outcomes. Serious gaming describes a technology that can educate and train while entertaining users. This type of training can be very useful for health professions because it improves learning outcomes creating a learner oriented approach and providing a stealth mode of teaching. In some fields it represents an ideal instrument for continuous health professions education also in terms of costs because it is cheaper than traditional training methods that use cadavers or mannequins. In this paper we make a scoping review of serious games developed for health professions and health related fields in order to understand if they are useful tools for health related fields training. Many papers confirmed that serious gaming is a useful technology that improves learning and skills development for health professionals.

Virtual Reality applications on Cultural Heritage are increasing, according to a general trend towards virtual reproduction and interaction mediated by the computer system. The effects of this trend, both on education and research, are still far from being completely tested and defined. The aim of the MediaEvo Project is to develop a multi-channel and multi-sensory platform for the edutainment in Cultural Heritage, towards integration of human sciences and new data processing technologies, for the realization of a digital didactic game oriented to the knowledge of medieval history and society. The developing of the project has enhanced interactions among historical, pedagogical and ICT researches, morphological inquiries, data management systems, by means of the definition of a virtual immersive platform for playing and educating. The platform is also intended to collect feedback and validate hypothesis and findings coming from researchers. This essay introduces the questions related to the educative use of ICT and describes the steps of the reconstruction of the town of Otranto in the Middle Ages: data collection and integration, organization of work and software applications.

Treatment of deformities, diseases or traumas of the facial skeleton is very important for the functional and aesthetic importance of this structure. Craniofacial surgical techniques have had a great development during last decades. However, some problems still remain regarding the accurate repositioning of skeletal components and in defining margins in complex oncological resections. Computer technologies aid surgeons to solve these problems but most of proposed solutions are based on Virtual Reality. Virtual Reality technology provides many advantages but also the disadvantage that the surgeon has to adapt the virtual planning to the real surgical field. Augmented Reality represents the solution to this problem. We are developing an Augmented Reality platform for computer assisted surgery in the field of maxillo-facial surgery. In this paper we present the development of a surgical planning module that is integrated in this platform. The novelty is that this is the first Augmented Reality platform that includes such advanced planning module.

The aim of the MediaEvo Project is to develop a multi-sensory platform for the edutainment in Cultural Heritage towards integration of human sciences and new data processing technologies, for the realization of a digital didactic game oriented to the knowledge of medieval history and society. The developing of the project has enhanced interactions among historical, pedagogical and ICT researches, by means of the definition of a virtual immersive platform for playing and educating and has permitted to investigate some navigation and interaction modalities among players for education purposes. In this paper we present some results of the MediaEvo Project that has led the researchers to use the reconstruction of the city of Otranto in the Middle Ages in order to determine the conditions for testing more elements of interaction in a virtual environment and a multisensory mediation in which merge objects, subjects and experiential context. With the aim to make interaction easier for users without any experience of navigation in a virtual world and more efficient for trained users, we use the Wiimote and the Balance Board of Nintendo in order to increase the sense of immersion in the virtual environment.

The visualization of 3D models of the patient’s body emerges as a priority in surgery. In this paper two different visualization and interaction systems are presented: a virtual interface and a low cost multi-touch screen. The systems are able to interpret in real-time the user’s movements and can be used in the surgical pre-operative planning for the navigation and manipulation of 3D models of the human body built from CT images. The surgeon can visualize both the standard patient information, such as the CT image dataset, and the 3D model of the patient’s organs built from these images. The developed virtual interface is the first prototype of a system designed to avoid any contact with the computer so that the surgeon will be able to visualize models of the patient’s organs and to interact with these moving the finger in the free space. The multi-touch screen provides a custom user interface developed for doctor needs that allows users to interact, for surgical pre-operative planning purposes, both with the 3D model of the patient’s body built from medical images, that with the image dataset.

In the information age the ability to develop high-level situational awareness is essential for the success of any military operation. The power of network centric warfare comes from the linking of knowledgeable entities that allows information sharing and collaboration. By increasing the number of commanded platforms, the volume of the data that can be accessed grows exponentially. When this volume is displayed to an operator, there is an high risk to get a state of information overload and great care must be taken to make sure that what is provided is actually information and not noise. In this paper we propose a novel interaction environment that leverages the augmented reality technology to provide a digitally enhanced view of a real command and control table. The operator, equipped with an optical see-through head mounted display, controls the virtual context remaining connected to the real world. Technical details of the system are described together with the evaluation method. Twelve users evaluated the usability of the augmented environment comparing it with a wall-sized stereoscopic human computer interface and with a multi-screen system. Results showed the effectiveness of the proposed system in understanding complex electronic warfare scenarios and in supporting the decision-making process.

Hepatic cancer is one of the most common solid cancers in the world. As surgery of hepatic cancer is seldom applicable, different solutions have been found to cure this disease. One of these is Liver Radiofrequency Ablation. This technique consists in a needle insertion inside the liver parenchyma in order to reach the tumor and in an injection of a radiofrequency current to cause tumor cell necrosis for hyperthermia. The needle placement task is really difficult because surgeon uses ultrasound, CT or MRI two-dimensional image to guide the needle. In this paper we present an Augmented Reality system to help the surgeon to place the needle as best as possible; the application can also help the surgeon during the preoperative planning because it offers various visualization modality of 3D models of the patient’s organs obtained from the medical images.

The practice of Minimally Invasive Surgery is becoming more and more widespread and adopted as an alternative to the classical procedure. This technique presents many advantages for the patients, but also some limitations for the surgeons. In particular, the lack of depth in perception and the difficulty in estimating the distance of the specific structures in laparoscopic surgery can impose limits on delicate dissection or suturing. The presence of new systems for the pre-operative planning can be of great help to the surgeon. The use of the Augmented Reality technology shows a way forward in bringing the direct advantage of the visualization of the open surgery back to minimally invasive surgery and can increase for the physician the view of the organs with information obtained from the image processing of the patient. The developed application allows the surgeon to get information about the patient and her/his pathology, visualizing and interacting with the 3D models of the organs built from the patient’s medical images, measuring the dimensions of the organs and deciding the best insertion points of the trocars in the patient’s body. This choice can be visualized on the real patient using the Augmented Reality technology.

In medicine, the augmented reality technology allows surgeons to have a sort of ‘X-ray’ vision of the patient’s body and can help them during the surgical procedures. This paper describes an application of augmented reality that could be used as a support for a more accurate preoperative surgical planning and also for an image-guided procedure. Augmented reality can support the surgeon during the needle insertion in the treatment of liver tumours with the radiofrequency ablation in order to guide the needle and to have an accurate placement of the surgical instrument within the lesion. The augmented visualisation can prevent as much as possible damages to the healthy cells of the liver.

Augmented Reality allows a more detailed understanding of a learning object. Aim of this work was to analyse embodied cognition of the learning object, when it is presented in 2D or in 3D presentation in AR. Our sample was composed by University Students that differed with respect to the knowledge of plankton (naïve and competent condition). The subjects had to manipulate in AR some Application about plankton. After the AR manipulation, the subjects had to perform a recognition task during an EEG recording. We examined Event Related Potential P1, N2 and P3 components. Main result of the study was a significant change in amplitude in the parietal and central left lobe in all components in direction of greater amplitude in naïve condition. We interpret these results like a modulatory effect in the interaction with augmented reality application.

In this paper the use of augmented realty and cloud computing technology to enrich the scenes of cultural heritage contexts is proposed. The main objective is to develop a mobile application capable to improve user cultural experience during city sightseeing through the addition of detailed digital contents related to the site or the monument he is watching. The Wikitude SDK is the software library and framework used for the mobile application development. The huge amount of culturale dig- ital contents (mainly represented by images) justifies the exploitation of a cloud computing environment to obtain an innovative, multi-platform and user friendly augmented reality enriched solution. In particular, for the purpose of our research we’ve chosen KVM and OpenNebula open-source cloud platform as private cloud technology, since it exhibits great features like openness, flexibility, simplicity and scalability. The result of the work is validated through test beds realized both in laboratory, using images captured from PC display, and in a real environment.

Surgeon training in laparoscopic suturing is very important because this task generally requires an high level of experience from the surgeon. Serious gaming refers to a computer games technology where the primary goal is to train the player. In this kind of training the education goal is achieved also ensuring the entertainment and the engagement factors typical of a traditional game. This paper presents the development of a serious game for training on suturing in laparoscopic surgery that is focused on the physical modeling of the virtual environment and on the definition of a set of parameters used to assess the level of skills developed by the trainees.

Network Centric Warfare can be accomplished thanks to a network of geographically distributed forces, granting a flow of increased contents, quality and timeliness of information, building up a shared situational awareness. When this flow is displayed to an operator, there is the possibility of reaching a state of information overload. To avoid this situation, new ways to conceive the interface between human and computer must be evaluated. This paper proposes an experimental stereoscopic 3D synthetic environment aimed to improve the understanding of the modern battle spaces. This facility is part of the LOKI Project, a Command and Control system for Electronic Warfare developed by Elettronica S.p.A. We discuss technical details of the system and describe a preliminary usability study. This first evaluation is very positive and encourages continuing research into Human-Computer Interaction for military applications.

In this work, the perception of affordances was analysed in terms of cognitive neuroscience during an interactive experience in a virtual reality environment. In particular, we chose a virtual reality scenario based on the Leap Motion controller: this sensor device captures the movements of the user's hand and fingers, which are reproduced on a computer screen by the proper software applications. For our experiment, we employed a sample of 10 subjects matched by age and sex and chosen among university students. The subjects took part in motor imagery training and immersive affordance condition (a virtual training with Leap Motion and a haptic training with real objects). After each training sessions the subject performed a recognition task, in order to investigate event-related potential (ERP) components. The results revealed significant differences in the attentional components during the Leap Motion training. During Leap Motion session, latencies increased in the occipital lobes, which are entrusted to visual sensory; in contrast, latencies decreased in the frontal lobe, where the brain is mainly activated for attention and action planning.

Aim of this work was to study the perception of affordances in VR according to a cognitive neuroscience. In order to investigate this topic we focused our analysis on the perception of affordances during a game, the Leap Motion Controller (LM). The sample was composed of 10 university students matched by age and sex. The subjects performed in Thinking training and in Immersive Affordance Condition (a virtual training with LM and a Real training). After each training the subject had to perform a recognition task. During the task ERP components were measured through EEG. The results highlighted that, during the LM training, attentional components changed. In the occipital lobes, which is entrusted to visual sensory, we got increased latencies; on the contrary, in frontal lobe, where the brain mainly activates for attention and action planning, we got decreased latencies.

Robotic Surgery is a current procedure in endosurgery, but literature has not addressed the learning curve for the use of the robotic assisted surgery. The learning curve for robot surgical procedures varies widely. Apart from innate skill, learning curves are composed of at least two fundamentals related to the volume of cases and the incidence rate. Commonly cited reasons include lack of adequate training in residency programs because of the time devoted to abdominal, vaginal, and obstetric procedures, lack of available and adequate training opportunities outside of dedicated fellowships, lack of proctors and mentor surgeons in communities to help to further advance the skills of younger surgeons, and lack of desire to leave established surgical practices to try to develop skills requiring long learning curves to master. Currently, the training involves practice with the surgical robot in either pig or human fresh tissue in a laboratory environment in order to become familiar with the functions of the robot, the attachment of the robotic arms to the robotic trocars, and the overall functions of the robotic console. In this chapter authors reviewed current literature on learning curve in robotic assisted surgery and screened problems linked to robotic surgical skills.

The MediaEvo Project aims to develop a multi-channel and multi-sensory platform for edutainment in cultural heritage for the realization of a digital didactic game oriented towards the knowledge of medieval history and society by means of the integration of human sciences and new data processing technologies. During the project it has been possible to test the possible interactions between historical research, morphological inquiries, data management systems and the definition of a virtual immersive platform for playing and educating. The platform has also proved to be a means for validating hypotheses and findings formulated by researchers. This paper introduces the theoretical questions related to the educative use of Virtual Reality technology and describes the steps of the reconstruction of the town of Otranto in the Middle Ages: data collection and integration, new historical acquisitions, organization of work, peripherals and software applications.

Serious games usually refer to games that are used for training, advertising, simulation, or education and that provide a high fidelity simulation of particular environments and situations. Serious games are starting to be also employed in surgery-based training applications. This paper presents a serious game for training on suturing in laparoscopic surgery. In particular, it is focused on the physical modeling of the virtual environment and on the definition of a set of parameters used to assess the level of skills developed by the trainees. A pair of haptic devices has been utilized in order to simulate the manipulation of the surgical instruments.

Situational awareness is especially important for an operator when carrying forward Network Centric Operations. The networking of knowledgeable entities allows them to share information and collaborate to develop a common operational picture. Increasing the number of commanded platforms may easily become overwhelming for an operator because of information overload and this results in making wrong decisions which may have disastrous consequences. This paper proposes the use of Stereoscopic-3D to increase the situational awareness and improve understanding of modern battle spaces in military operations. The advantage of using S3D visualization is evaluated by several users who operate LOKI, a Command and Control system for Electronic Warfare developed by Elettronica S.p.A. Different tasks and types of threats are considered. The obtained results are presented, which show clear advantages when the operator’s interface benefits from S3D viewing.

3D stereoscopic visualization provides a user with higher comprehension of remote environments in teleoperation when compared to 2D viewing. Works in the literature have shown how stereo vision may contribute to improving perception of some depth cues, but it is hard to find work assessing stereoscopic-3D viewing in telenavigation tasks involving medical flexible endoscopes. Nonetheless, the increased level of depth awareness provided by stereo-viewing is remarkable, which facilitates endoscope teleguide, teleexploration, and teleintervention, leading to accurate navigation and faster decision-making. This work assesses stereoscopic-3D visualization in medical endoscopic teleoperation. We evaluate the usability of a flexible stereoscopic Bronchoscope. Twenty test-users are asked to teleguide a virtual endoscope, which operates in a realistically simulated bronchus environment under different viewing conditions and displays. The evaluation involves 7 systems (from laptops to all-screen and HMD), 4 approaches to stereo viewing (colored-anaglyph, polarized-filters, shutter-glasses and separated displays); 5 types of display technologies (DLP, CRT, LCD, LED, OLED). The results show a strong improvement in users’ performance when the endoscope-camera view is (depth-) enhanced by stereo viewing. Users’ performance and appreciation may vary in different systems, which is also commented in our paper. This study supports system designers in making informed decisions.

Laparoscopy is the standard of treatment for many gynecological diseases, it is a very common procedure in gynaecology and it is widely accepted as the method of first choice for many gynaecological problems. A meta-analysis of 27 randomized controlled trials comparing laparoscopy and laparotomy for benign gynaecological procedures concluded that the risk of minor complications after gynaecological surgery is 40% lower with laparoscopy than with laparotomy, although the risk of major complications is similar. Laparoscopy has been considered a real alternative to laparotomy with numerous advantages: short hospital stay, less need of analgesia, low intraoperative blood loss and faster recovery time. Many researchers are in pursuit of new technologies and new tools of minimally invasive technologies for reducing laparoscopic complications. The industry responded to these demands with many innovations, such as new optical instruments and digital images, virtual and augmented reality, robotic assisted surgery, etc. In this chapter, authors discussed the possible utilization of novel technologies to reduce the risk of laparoscopic gynecological complications.

The military strategy to obtain information superiority is enshrined in the concept of Network Centric Warfare: a modern doctrine based on the interconnection of knowledgeable entities. By increasing the number of commanded platforms, the volume of the data that can be accessed grows exponentially with a high risk to get a state of information overload. This paper proposes an augmented environment for efficient command and control in net-centric operations. Touchless interaction by means of Leap Motion has been explored in order to provide a faster and more natural way to issue commands and increase situational awareness. The proposed approach was evaluated by twelve users who performed different tasks on Loki, a command and control system for electronic warfare developed by Elettronica S.p.A. The results show a strong improvement in users’ performance (i.e., completion time, number of failures, failure rate) and experience (i.e., control simplicity, level of immersion and situational awareness).

Nowadays, in the digitalization era, it is becoming ever more pertinent to have reasonable use of digital content. This consideration should also apply to cultural heritage, not only conservation. In the context of globalization, smart actions for content use should be carried out to provide sustainability of national identities. In the last decades, new technologies have been developed and used for digital conservation in the form of three-dimensional computer models with varying size, starting from very small museum exhibits and ending with the largest cathedrals and castles. The benefits computer models are undeniable. By prototyping and reverse engineering, significant exhibits are developed providing possibilities not only to see, but also to hold in one’s hands and interact thereby allowing a better understanding of historical events and their meaning. Three-dimensional visualization provides virtual tours in different places and in different times. Unfortunately, development of such content is very expensive. Furthermore, technologies for a successful immersion level are in the development phase. This applies to criteria of content quality and availability and functionality of interaction. It is also vital to understand what elements to virtualize and how it lines up with the provision of national identity. Competition and tourism promotion conditions are undoubtedly a significant driving force for technological development, but, from an identity sustainability point of view, it is important that they go hand in hand. The aim of this research is to develop a baseline design for a set of technologies and the use of virtual and augmented reality to find recommendations for the sustainability of the national identity of countries via the prism of cultural heritage. Thereby providing planned and global technological solutions that are not aimed towards individual museums and separate objects of cultural heritage but focused on the overall region in the specialisation of ancient sites.

The main goal of the Human-Computer Interaction technology is to improve the interactions between users and computers by making computers more usable and receptive to the user's needs. The end point in the interface design would then lead to a paradigm in which the interaction with computers becomes similar to the one between human beings. This paper focuses on an application of navigation and interaction in a virtual environment using the Nintendo Wiimote and the Balance Board. The idea is to have a system of navigation control in a virtual environment based on a locomotion interface in order to make the interaction easier for users without any experience of navigation in a virtual world and more efficient for trained users. The application has been developed for the navigation and interaction in the virtual town. We chose Otranto as an example town; Otranto is located in the easternmost tip of the Italian peninsula and, due to its geographical position, the town was like a bridge between East and West. The virtual environment is a loyal representation of the town of Otranto in the Middle Ages.