Anatomy is often viewed as a settled science.
But for R. Shane Tubbs, PhD, MS, PA-C, the first American to serve as co-editor-in-chief of the international edition of “Gray’s Anatomy,” advances in imaging continue to reshape how clinicians understand the human body.
Tubbs, Tulane University’s anatomical research director, served as co-editor-in-chief of the textbook’s 43rd edition, published in 2025, alongside Susan Standring, emeritus professor of anatomy at King’s College London. Tubbs is the first American to hold the role in the international edition’s 168-year history. Previous editor-in-chief roles had been held exclusively by British anatomists.
While “Gray’s Anatomy” remains one of the world’s most widely used medical references, Tubbs said the discipline it documents continues to evolve in ways that directly affect clinical practice.
Anatomy Is Still Evolving
“Anatomy is often considered a static discipline with no room for discovery,” Tubbs said. “However, I would impress upon practicing PAs that this field is always evolving. Not only are new anatomical structures identified, but a better understanding of the standard anatomy is found.”
Advances in imaging technology and surgical visualization tools are helping drive that evolution. New modalities and higher-quality imaging allow clinicians to view structures in ways that were not previously possible.
“Ultrasound is now so prevalent and of such high quality that PAs can identify structures previously not seen outside CT or MRI,” Tubbs said. “Ultrasound is also dynamic, so visualizing various anatomical structures with this modality brings internal structures into clearer view than ever before.”
As clinicians gain access to more detailed and real-time views of anatomy, Tubbs said the emphasis must shift beyond memorization.
“Ultimately, the goal is not just anatomical knowledge, but anatomical application in real-time clinical decision-making,” he said.
Bringing New Discoveries
That focus on clinical relevance is reflected in the 43rd edition of “Gray’s Anatomy,” which remains both a foundational educational text and a widely used clinical reference.
“For the 43rd edition of ‘Gray’s Anatomy,’ as with previous editions, we strive to update the book with new findings and discoveries, verify each statement at the source and ensure the content is up to date and aligned with current practice,” Tubbs said. “This necessitates having leaders in the field, mostly clinicians or surgeons, who author each of our chapters.”
The integration of imaging into anatomy has also changed how the discipline is taught and understood.
“The integration of cross-sectional imaging with anatomical education has effectively shifted anatomy from a purely descriptive science to a clinically applied, image-based discipline,” Tubbs said. “Structures that were never seen on an imaging study can now be visualized and considered when planning patient care.”
New Perspectives Through Minimally Invasive Care
Minimally invasive procedures, including endoscopy, further illustrate how anatomy is being applied differently in modern medicine.
“Anatomy that was once viewed during an open procedure must now be understood in a small, magnified field,” Tubbs said. “These procedures improve patient care but highlight how PAs must adapt and ‘reorient’ their understanding of anatomy.”
The growing use of minimally invasive techniques requires clinicians to understand anatomical relationships from perspectives that differ significantly from traditional surgical views.
Staying Current With Anatomical Advances
Tubbs said practicing PAs do not need to be immersed in academic research full-time to stay informed about new anatomical developments.
“One easy way to do this is to simply use search engines such as PubMed and query ‘anatomy’ and a recent time frame, e.g., ‘2026,’” Tubbs said. “This search can then be trimmed down to the anatomical structure the reader is most interested in seeing updates on.”
Clinicians can further refine searches by limiting results to human studies and English-language publications, he said.
“AI is also a powerful tool for identifying what’s new in a particular anatomical field,” Tubbs said.
Understanding Anatomical Variation
For PAs working in surgery and specialty care, Tubbs said understanding anatomical variation is critical because it can directly affect patient outcomes.
“Human anatomical variation is normal and must be considered for each patient,” Tubbs said. “Understanding the spectrum of normal variation is often more clinically important than memorizing a single textbook configuration.”
“Such variants can result in pathology, and some, if not known, can result in iatrogenic injury,” Tubbs said. “Therefore, PAs should at least be familiar with the more common anatomical variations applicable to their fields of practice.”
Before assuming the co-editor-in-chief role, Tubbs served as a section editor for the 41st and 42nd editions of “Gray’s Anatomy.” He is already working on the 44th edition while continuing his anatomical research at Tulane.
R. Shane Tubbs, Ph.D., MS, PA-C
R. Shane Tubbs, Ph.D., MS, PA-C, is a Board Certified PA, clinical anatomist, professor and interim chair of the Department of Neurosurgery at Tulane University School of Medicine. He is the first American co-editor-in-chief of Gray’s Anatomy and editor-in-chief of the journal “Clinical Anatomy.” His research centers on applying anatomical discoveries to improve patient care.