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By Karen Sandrick

The fundamentals of human anatomy have not changed, of course, since Henry Gray wrote his definitive text in 1918. But understanding of the intricacies of anatomical structures and their relationships has grown, thanks to the work of basic radiology researchers using advanced techniques such as MRI.

And in the area of musculoskeletal anatomy, few have made greater contributions than Dr. Donald Resnick, a professor of radiology at the University of California, San Diego and chief of osteoradiology at the VA Medical Center, San Diego.

Ever since he began investigating the musculoskeletal system in his first research projects in the 1970s, Resnick has been trying to augment his understanding of bone and soft-tissue anatomy, primarily by scanning cadavers with MRI and matching radiologic findings with dissection specimens and pathology. The result is more than 800 scientific articles in 120-plus journals, detailing anatomic architecture ranging from the tendon sheaths of the hand and wrist to the intermetatarsal spaces and the abductor mechanism and bursae of the hip. And in the process, he's been illuminating the unique imaging characteristics of the musculoskeletal system.

"Clearly, the anatomy of the brain or the heart is complex, but the anatomy of the musculoskeletal system changes so much from one area to the next. There's a tremendous challenge in learning musculoskeletal anatomy. It keeps us thinking and studying and doing our basic research," he said.

Long before musculoskeletal imaging became a subspecialty, Resnick was captivated by the luminescent properties of the skeleton.

"Bone is the best contrast agent," he said. "It's a tissue that is dense and produces very vivid images, and the findings from imaging as they relate to the skeletal system are more specific. You not only can see an abnormality, but often can offer a more definitive diagnosis than with a chest disease or GI problem."

Skeletal abnormalities were also the most common conditions his father saw as a one-man private-practice radiologist in New York in the 1950s. Resnick was attracted to radiology because it forms the hub of a hospital; it influences all aspects of medicine and brings radiologists into one-on-one contact with other physicians, he said.

He attributes much of his desire to become a radiologist and to specialize in researching the musculoskeletal system to his father, who handled every step of the imaging process: He escorted patients into the office, prepared them for x-rays, took the pictures, developed the films with the various wet solutions available at the time, read the films, and wrote the reports.

Resnick's first forays into radiology practice involved delivering his father's reports to physicians who had ordered x-ray studies, typically to confirm suspected fractures. In college he began learning radiology at his father's viewbox. Resnick still has some of his father's cases in his teaching file. Some have crumbled, but all bear his father's handwritten notes.

Resnick has been intimately involved with the growth of musculoskeletal imaging research as improvements in imaging technology led the way. He recalls the days when radiologists had only plain x-ray films to work with. Plain films clearly portray bones, demarcate the spaces between bones, and trace pairs of bones as they articulate at a joint, he said, but they only indirectly assess the relationships between the skeleton and soft biomechanical tissues. Radiology researchers couldn't tease out the differences between cartilage and ligaments and intertwining tendons because x-rays made them all look the same: indistinguishable shades of gray.

But with the advent of CT and MRI, Resnick could begin discerning the lighter and darker shades of pale associated with individual ligaments and tendons. With MRI, he could visually dissect fine musculoskeletal structures, differentiate normal from abnormal aspects of soft tissues, and describe the imaging findings for tears, separations, evulsions, avulsions, and deformities. And in the process, he helped sow the seeds of future research in musculoskeletal imaging.

Although the musculoskeletal system is a hot area for radiology fellows today, Resnick remembers that fellowships in bone radiology were almost unheard of in the '70s, when plain film was the predominant form of imaging. It has only been since the '80s and the introduction of MRI that bone fellowships have become available. They have flourished with the recognition of the technique's adroitness in depicting diseases of bones, soft tissues, and joints, he said.

Resnick currently oversees one of the largest fellowship programs in musculoskeletal imaging in the country. He has trained 138 fellows, 73 of them from the U.S., in musculoskeletal radiology and has schooled many of the leaders in the field, according to Dr. Jeremy Kaye, vice chair of radiology and associate resident program director at Vanderbilt University.

Kaye enumerated some of Resnick's other accomplishments: delivering 30 named lectures, achieving honorary membership in 10 societies, and serving as a visiting professor at 130 institutions.

Resnick received the Schinz Medal from the Swiss Society of Radiology in June and will receive the Founder's Medal from the International Skeletal Society in September. The American Roentgen Ray Society presented him with its gold medal award in 2001.

Despite a heavy teaching, lecturing, writing, and research schedule, Resnick still makes time for his colleagues, according to Kaye, who has known Resnick since they were both residents at Cornell University-New York Hospital in the late 1960s.

"He is regarded as a friend by virtually everyone in musculoskeletal radiology and by many from other fields. He always seems to have the time to talk to people about their issues and problems," Kaye said.

Resnick seeks to impart to radiology residents and fellows the enthusiasm and joy with which he approaches his work. He describes the ideal academic radiologist as a triple threat: a clinical radiologist, teacher, and researcher. In the real world of academic radiology, however, you can realistically find only double or single threats, he said.

"It would be great if you could find someone who was complete in all three areas, but it's hard to be good in all of them. So you have to choose which of the three you want to be proficient in. The two that I enjoy most are teaching and clinical work. If you can combine that with some form of research, you probably have a good radiologist."

Ms. Sandrick is a freelance writer in Chicago.