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Wounded Willy And Damaged Debbie

60 traumas and pathologies divided between Willy and Debbie
Can be positioned realistically
Human technical factors
Unlimited repetition of views without human exposure
Radiographs that permit evaltuation of trainee performance
Teaching/training for civilian hospital ER's

The concept of grouping a large number of casualties in two teaching/training phantoms was originated by the Fleet Hospital & Operations Training Center, Camp Pendleton, California. WOUNDED WILLY and DAMAGED DEBBIE were designed and constructed by Radiology Support Devices, Inc. of Long Beach, California.

Design Principles for radiographic teaching training room

It is a universally-accepted fact of life that people cannot be subjected to diagnostic radiography for other than medically-necessary purposes. Observance of this principle rules out the use of patients for basic training in these procedures (but permitting the use of patients for advanced, supervised training).

The re-creation of the human body, in all of its immense complexity, represents overkill for radiographic training. One example of a widely-accepted divergence from precise reproduction of the human is the use of transparent phantoms to combine the teaching of radiography with that of anatomy.

Whichever philosophy is pursued, the basic qualifiers of human substitutes are phantoms that yield radiographs resembling those of the human, taken with human technical factors, articulated to enable basic views to be presented, and with an appropriate level of human anatomy.

A phantom is a “trade-off” between acceptable anatomic detail and unacceptable impact of artifacts on the image. WILLY and DEBBIE are based on several decades of experience with “trade-offs”, variously driven toward one extreme or another. They yield human-like images, with human technical factors and with limited artifacts, (which are presented clearly as artifacts, not as anatomic detail). They are well-balanced patient substitutes for basic training of radiologic technologists, particularly in military or emergency room environments.

Willy And Debbie Teaching/Training Capabilties

They demonstrate and evaluate positioning and imaging techniques, including kVp, mAs, contrast, optical density, OFD and TFD. Their radiographs are optically equivalent to humans in density and contrast.

WILLY AND DEBBIE DIFFERENCES:

The most obvious difference between them is in the complement of traumas and pathologies assigned to each.

Another difference is that DEBBIE has female breasts, while WILLY has natural male chest contours. DEBBIE is fitted with a wig, while WILLY is bald. They are dressed in camos for military training and in jumpsuits for civilian training.

Realism of Traumas And Pathologies

There is no single, unique description of any of their traumas and pathologies. Rather, there are limitless variations among a broad range of casualties. The most meaningful judgments of the realism of trauma and pathologies are those based on long radiographic experience across the spectrum of casualties.

Patrick Hale, Senior Radiologic Technologist at the UCLA Emergency Room and an RSD consultant, made those judgments with respect to WILLY AND DEBBIE.

The size and weight of PIXY are also used for WILLY and DEBBIE. They are small adults. Since technologists must learn to work with patients of all sizes and weights, a smaller phantom is as valid for training as a larger phantom, and position is facilitated. Each is 5 ft. 1 in. tall (156 cm) and weights 105 lbs (48 kg).

WILLY and DEBBIE are articulated at the neck, shoulders, elbows, hips and knees. Fractures of the left shoulder and left hip are located in DEBBIE. To minimize handling problems, all other traumas of the arms and legs are located in WILLY and on the right side of DEBBIE. The articulations provide a broad range of positioning of capabilities, even the "frog position".

Lungs are molded of durable materials with radiodensities matched to humans in a median respiratory state. Animal lungs matching the human in size and blood vessels are available, but they are oriented towards research rather than training.

WILLY and DEBBIE have solid "soft tissues" that are hard and rigid. They cannot be palpated to locate traumas. However, radiological technologists are generally informed by the physician as to the views to be taken. The manual provides this information to instructors.

RSD-manufactured skeletons are used rather than natural human skeletons. The latter are generally unavailable and usually consist of an assortment of bones ranging from children to adults of ages for which osteoporosis becomes a factor.

RSD skeletons are not to be confused with plastic skeletons for teaching anatomy. RSD skeletons are made to fit the soft-tissue molds precisely. They have spongiosa moldings within marrow cavities and outer, cortical bone. Both constituents meet the internationally-accepted standards for radiodensity and specific gravity.

Traumas and pathologies are listed below. External markings are: N (none), O (open wound), S (swelling), H (bullet or foreign body hole), B (bruise), Side (R.L.), E (WILLY or DEBBIE).

Willy
Willy
Willy
Willy
Willy
Willy
Debbie
Debbie
Debbie
Debbie

Metallic fragment in orbit
Multiple fragments lower face
Step deformity of intraorbital rim
Separated fracture of frontal zygomatic suture
Metallic foreign body over skull
Mandible fracture with missing bone
Depressed comminuted fracture of zygomatic arch
Mandibular fractures
Cloudy maxillary sinus
Fracture of nasal bones with mild displacement

An axial duct is seen above. It is filled by a polycarbonate rod to assemble the head and neck to T1. When assembled, the duct artifact is barely visible.

Anatomic and mechanical necks are interchangeable between WILLY and DEBBIE.

Heads are interchangeable between WILLY and DEBBIE

Number	WILLY/DEBBIE	Description	Side	External Marking
11,12	WILLY	Displacement fracture of mandibular condyle	L&R	S

Traumas and pathologies are listed below. External markings are: N (none), O (open wound), S (swelling), H (bullet or foreign body hole), B (bruise), Side (R.L.), E (WILLY or DEBBIE).

Among the “trade-offs” required in these phantoms is that between anatomic fidelity and the ability to move the head into a broad range of views is required in radiography. No mechanism can be designed for intervertebral motion without artifacts obliterating the radiographs.

This problem has been solved by the use of two necks. One is a multi-articulated polycarbonate assembly which provides for nearly all commonly used views. There is no attempt at radiographic realism in this neck. An alternate, fully-realistic neck is interchangeable with the mechanical neck. The cervical spine of this neck contains traumas.