A Radiologist and His Anterior Mid-Cingulate Cortex

I have mentioned in a few blogs that, before aiming for a career in radiology, I targeted psychology. One might not see any similarities between the two whatsoever.

In radiology, pretty much everything can be seen objectively. You can measure it, describe shape, consistency, even things like velocity and biochemical function. You don’t see much of that going on in the world of mental health. It’s kind of the dividing line between psych and neuro. It was a fun little irony for me: Going into rads, the one specialty I had known best would be the most absent from my work.

That has historically been the case with radiological tools. However, scientific understanding and technology progress, and every now and then a smidge of rad/psych overlap turns up. The anterior mid-cingulate cortex (aMCC) provides an interesting case in point.

I recently came across a podcast featuring Andrew Huberman, a neuroscientist/podcaster, talking about this little slice of gray matter. It has been studied for much longer than he has been around. You can find a detailed review at https://pmc.ncbi.nlm.nih.gov/articles/PMC7381101/ .¹

I won’t even try to get into details here, but the aMCC has been justifiably considered a center of “willpower” or “tenacity” for the brain. It actually undergoes growth in folks who push themselves to do things (like exercise and maintaining good dietary habits) hey don’t want to and shrinks in those who don’t.

Someone inclined toward subjective stuff like psychology might not be surprised or even particularly interested by this news. Of course you strengthen your resolve and “grit” by exercising it. Getting into good habits is adaptive, and falling out of them is maladaptive. There is no mystery here. We didn’t need any physical, measurable quantification for this.

By contrast, the neuro/rad folks get more attentive with this move from conceptual to concrete. As the aMCC changes in volume, we can quantify it on a scan. We are accustomed to seeing musculoskeletal growth in folks who do physical exercise. Now we can consider willpower or whatever you want to call it as something similarly “real,” able to be developed and improved by anyone who puts in the work.

As an old science teacher of mine liked to say, after telling his classes something that seemed to have no real-world consequences: Okay, so what?

There is a cascade of real-world benefits to exercising your aMCC. Increasing your gumption in one area makes it more of an ally in others. You might start by pushing yourself to exercise when you don’t feel like it or refraining from reaching for the chips when you know they are no good for you. That indirectly bolsters your ability to turn off the TV and get to overdue but necessary chores like straightening up the house, tending to your car or yard, or prepping your taxes before April 14.

This circles back to radiology. I didn’t just bring this up because one can measure the aMCC on imaging (although that is what made this so much more tangible for me). I have seen its impact in my career, and I am far from alone in this.

I have bounced around a few different working environments. Some have had efficient tools and infrastructure, others not so much. Some made it more possible to get ahead and do better for oneself. Nobody handed out success on a silver platter. I still had to reach out and take it, but it wasn’t always even an option.

When I have been in the latter situation for more than a little while, I have adjusted to it. There is no point in beating your head against the wall, striving for things like an RVU bonus threshold if the case mix you are being fed makes it impossible to attain.

Circumstances change. Sometimes what had been unattainable comes back within reach. If you have been dwelling in a “there’s no point in trying” world, however, you might not be poised to make efforts even after they become relevant. I have found myself getting comfortable, if that’s the right word, in not even trying.

Maybe my aMCC atrophied a bit while I was force-fed a steady stream of low-value XR, and now I am accustomed to this radiological equivalent of junk food even when higher value CT and MR come back on my list. I might not be motivated to reach for those cases, continuing with a diet heavy in XR because the cross-sectional stuff feels more like, well, work.

A similar phenomenon occurs with subspecialty or complex cases. Staying within your diagnostic “comfort zone” can slowly shrink the range of imaging studies you are willing/able to read. What starts as shying away from, say, thyroid ultrasounds today ends with your no longer feeling competent to read them a few years down the line.

Meanwhile, rads who don’t allow their sphere of capability to shrink can even push back their frontiers, learning new things because they have exercised their ability to do so. PET was becoming popular when I was in residency. It seemed pretty straightforward to learn and a valuable modality to know. It amazed me how many older rads seemed mystified, even scared of it. The result was that simply being able to say “I read PET” opened a surprising number of doors for me.

A strong aMCC stands ready to help you numerous times each day. Any time something comes up that gives you a choice between mentally bellowing “charge!” versus “retreat,” you are better equipped for the former.

Reference

1. Touroutoglou A, Andreano J, Dickerson B, Barrett LF. The tenacious brain: how the anterior mid-cingulate contributes to achieving goals. Cortex. 2020 Feb:123:12-29. Doi: 10.1016/j.cortex.2019.09.011.