We propose an architecture for a real-time multimodal system, which provides non-contact, adaptive user interfacing for Computer-Assisted Surgery (CAS). The system, called M/ORIS (for Medical/Operating Room Interaction System) combines gesture interpretation as an explicit interaction modality with continuous, real-time monitoring of the surgical activity in order to automatically address the surgeon’s needs. Such a system will help reduce a surgeon’s workload and operation time. This paper focuses on the proposed activity monitoring aspect of M/ORIS. We analyze the issues of Human-Computer Interaction in an OR based on real-world case studies. We then describe how we intend to address these issues by combining a surgical procedure description with parameters gathered from vision-based surgeon tracking and other OR sensors (e.g. tool trackers). We called this approach Scenario-based Procedure and Activity Monitoring (SPAM). We finally present preliminary results, including a nonco...