modified radical neck dissection
Date:
The different types of neck dissection are classified based on the site (zones I-V) from where nodes are being removed and whether the following three important surrounding structures are removed: Apart from modified radical dissection, the other types include: The goal of neck dissection is to remove all cancer while preserving as much healthy tissue as possible. At this point, the posterior triangle contents, with or without the SAN and SCM, have been elevated to the lateral aspect of the IJV. Use cautery to separate the SCM attachments posteriorly from the skin and mastoid tip. Am J Surg. John Werning, MD, DMD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck SocietyDisclosure: Nothing to disclose. Sobol S, Jensen C, Sawyer W 2nd, et al. Levels I, II, and V have also been divided into sublevels, and the anatomic and radiographic boundaries of each level and sublevel have been clarified. Although complications are rare for experienced head and neck surgeons, they naturally occur also after elective neck dissection (END). A conservation technique in radical neck dissection. Buckley JG, Feber T. Surgical treatment of cervical node metastases from squamous carcinoma of the upper aerodigestive tract: evaluation of the evidence for modifications of neck dissection. As the last fibers of the SCM are divided, the internal jugular vein and omohyoid muscle are fully exposed. Head Neck. and transmitted securely. Bladder Neck Transection. If you log out, you will be required to enter your username and password the next time you visit. 1977 Dec;103(12):705-6. doi: 10.1001/archotol.1977.00780290041003. Robotic total thyroidectomy with modified radical neck dissection via unilateral retroauricular approach. Bocca E, Pignataro O. Epub 2014 Sep 17. Incisions that result in a trifurcation are less desirable because of the potential for distal flap necrosis and carotid artery exposure. These modifications are described in relation to which structures are preserved: Type I: Spinal accessory nerve is preserved. Modified radical neck dissection. Martin H, Del Valle B, Ehrlich H, et al. After discussions with an onologist and my surgeon a Modified Radical Neck Dissection was performed on Jan 6th. Laryngoscope. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Inspection and palpation are used to assess for IJV thrombosis, encasement of the IJV or SAN, and extracapsular involvement of the SCM. The plane of dissection should be just superficial to the adventia of the vein. 47:1780-1786. [QxMD MEDLINE Link]. J Craniomaxillofac Surg. [QxMD MEDLINE Link]. Modified radical neck dissection (MRND). There are different types of modified radical neck dissection. The difference between the modified and radical/complete dissection is that the modified spares at least one (or more) of the other structures that are removed during a radical dissection. These contributions are divided inferior to the submandibular ganglion. Post-op patients experience variable loss of sensation or blunted sensation around the wound and in the areas described. [QxMD MEDLINE Link]. However, in addition tonodes and lymphatics, it also removes the SCM, submandibular gland, tail of the parotid gland, internal and external jugular veins, cervical sensory nerves and CN 11. 1993 Nov-Dec. 15(6):546-52. Am J Surg. APPOINTMENTS: (919) 784-2735 The most important permanent risk of surgery involves nerve injury. Since then, the focus of criticism against the RND has addressed the related morbidity, causing other surgeons, including Jesse and Ballantyne, to search for cervical lymphadenectomy procedures that could provide oncologic cure with less morbidity. Raleigh, NC 27607, TELEPHONE: (919) 784-7874 Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck SocietyDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan, Ryte, Neosoma, MI10
Received income in an amount equal to or greater than $250 from: , Cliexa;;Neosoma
Received ownership interest from Cerescan for consulting; for: Neosoma, eMedevents, MI10. University of Iowa
More than 60% of patients have their disease controlled with MND. Risk & Post-Op Issues (Modified Radical neck Dissection) Created on March 28, 2016 by Dr. Kirk Faust in Thyroid Thyroid Modified radical neck dissection (MND) is a complicated operation. The lymph nodes are removed to prevent cancer . Indications for MRND-I is in bulky nodal disease with extracapsular spread involving the SCM and IJ, where the accessory nerve is free of . Consequently, the indications for MRND and selective neck dissection in these patients also remains poorly defined. Subsequently, investigators have questioned the need for dissection of sublevel IIB, IV, and the apex of level V (sublevel VA) in some clinical situations. During surgery, trauma to the IJV should be minimized by atraumatic manipulation and avoiding IJV desiccation. In addition, these studies differed in their indications for neck dissection, use of preoperative or postoperative radiotherapy, and follow-up interval. Injury to this nerve will compromise shoulder function especially raising the shoulder. Radical Neck Dissection This operation has been used for almost 100 years and describes the removal of lateral neck nodes and tissues to surgically remove cancer in the neck. The contributions from the cervical nerve roots from C2, C3 and C4 and scar branch are ligated. Although the term MRND strictly implies a comprehensive dissection of levels I-V, in the context of thyroid cancer, dissection . Flap elevation proceeds posteriorly immediately deep to the subcutaneous adipose tissue back to the anterior border of the trapezius muscle. This is a large thin-walled lymphatic vessel that is present at the base of the neck and empties lymphatic fluid from the body into the blood stream at the jugular vein on the left side of the neck. modified neck dissection Surgery A subtotal resection of the neck region, usually for CA of the floor of the mouth; most MNDs preserve the spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle. Shah retrospectively reviewed 1081 patients who underwent 1119 RND procedures with an average harvest of 39 lymph nodes. The lymph node-bearing fibroadipose tissues in this region are also rotated under the SAN in the same manner that dissection of sublevel VA was performed, up to the lateral aspect of the IJV. Modified radical neck dissection (MRND). Antibacterial ointment is then applied to the incision line. A second surgery is usually required to take care of this problem. The nerve to the lower lip (Ramus Mandibularis). Transect the vein between ligatures. [8] The morbidity associated with bilateral IJV resection has led to staged procedures or recommendations for IJV reconstruction in which bilateral IJV resection is necessary. 1984 Jul. Modified radical neck dissection (MRND). Upfront chemoradiotherapy can also be a valid therapy technique however, as with N2 illness, patients requiring salvage surgery endure . The most widely accepted terminology for categorizing the lymph node groups in the neck was originally described by head and neck surgeons at Memorial Sloan-Kettering Cancer Center, dividing the neck into 5 regions. The Vagus Nerve. Neck dissection is surgery to remove the lymph nodes in your neck. The .gov means its official. A closer look at the individual findings of Byers and Shah, however, can provide clinicians with applicable information that supports the use of the MRND in properly selected patients. 1992 Mar-Apr;16(2):222-6. doi: 10.1007/BF02071524. An image depicting a neck dissection incision can be seen below. KIRK B. FAUST MD Robbins KT. Download scientific diagram | Case 1. Robbins KT, Clayman G, Levine PA, et al. The superior SCM and the supraspinal posterior triangle may be too bulky to rotate underneath the SAN, requiring removal in 2 pieces. Identify the angle of the jaw, mastoid tip, midline of the neck, anterior and posterior borders of the SCM muscle and the clavicle. Head and neck cancers include cancers of the throat, lips, nose, mouth, larynx, and salivary glands. [QxMD MEDLINE Link]. A rational classification of neck dissections. Philadelphia, Pa: WB Saunders Co. 1988:645-669. Laryngoscope. If simultaneous IJV ligation is performed, IJV reconstruction with a greater saphenous vein graft should be considered. Shah JP, Candela FC, Poddar AK. [QxMD MEDLINE Link]. Neck dissection. Modified radical or a radical neck dissection has a job in each the healing and palliative setting. Depending on the tumor invasion, the doctor may either remove most of the lymph nodes between jawbone and collarbone on oneside of the neck and may or may not remove oneor more of the following: Modified radical neck dissection is usually considered for: This type of neck dissection is performed when there is evidence of more extensive involvement of lymph node metastasis. 1992 Apr. In 1980, a method for modified radical neck dissection was reported and then accepted as a substitute for classic neck dissection. official website and that any information you provide is encrypted https://emedicine.medscape.com/article/849834-overview#a3. Laryngoscope. A technique of modified neck dissection, which excludes dissection of the posterior triangle and spares the sternocleidomastoid muscle and spinal accessory nerve, has been described. Female surgeon in operation room with reflection in glasses, A surgeon systematically removes lymph nodes in the neck so that a pathologist can determine if they are cancerous. However, 7 of these studies were published before the development of a standardized classification for neck dissections, and modified neck dissections at that time included both the MRND and the selective neck dissection. Schiff BA, Roberts DB, El-Naggar A, et al. Patency of the internal jugular vein following modified radical neck dissection. Many patients with N3 disease (nodal metastases > 6 cm) require RND, but MRND can be considered when dissection is feasible. Radical neck dissection - discharge; Modified radical neck dissection - discharge; Selective neck dissection - discharge. The omohyoid muscle is now visualized superficial to the carotid sheath (arrow). Byeon HK, Holsinger FC, Tufano RP, Chung HJ, Kim WS, Koh YW, Choi EC. Concerns regarding sternocleidomastoid muscle (SCM) resection focus mainly on the cosmetic deformity that results from loss of muscle mass and the subsequent change in normal contours of the anterior neck. Injury to this nerve will cause significant voice problems because the recurrent laryngeal nerve is a branch of this nerve. Shoulder immobility or spinal accessory nerve palsy is reported as the most common complication occurring in 10% of patients after selective or modified radical neck dissection [ 9 ], but with preservation of . These can usually be removed en bloc with the remainder of the dissection in a posteroanterior fashion, sharply incising the fascia of the jugular vein with a scalpel blade using a feather-light touch. (b) Line drawing identifying landmarks. 2002 Jul. An official website of the United States government. [2] The procedure uses, in Crile's words, "a 'block dissection' of the regional lymphatic system . Jesse RH, Ballantyne AJ, Larson D. Radical or modified neck dissection: a therapeutic dilemma. Krause HR. The SCM can also serve a protective function for the carotid artery when flap necrosis or fistula formation occurs. (Their findings are reviewed in the section Supporting Evidence.). As the cervical rootlets are encountered, they are transected high (adjacent to the specimen) to prevent injury to the phrenic nerve. 2005 Nov. 27(11):963-9; discussion 969. This is a small bundle of nerves on either side of the back bone that are responsible for a variety of unconscious neurologic function. Iowa City, IA 52242-1089, Editor: Henry Hoffman, MD
The posterior triangle contents posterosuperior to the nerve (sublevel VB) are rotated under the nerve inferiorly. This description is combined with intraoperative photographs and . Preservation of the IJV may also facilitate microvascular surgical reconstruction. Byers reviewed 182 functional neck dissections that did not receive postoperative radiotherapy. Dulguerov P, Soulier C, Maurice J, et al. [QxMD MEDLINE Link]. The purpose was to effectvely remove all of the lymph nodes present in the neck and their interconnecting lymphatics. Arm weakness and and poor motor control could occur with injury. Most recently, Terrell and colleagues found that neck dissections sparing the spinal accessory nerve (SAN) were associated with less shoulder and neck pain and less need for pain medications than dissections not sparing the SAN. [7]. [4] Similarly, in 1952, Ewing and Martin evaluated 100 patients who had undergone RND. Terms of Use. A skin incision is made that optimizes exposure of the neck. Current status of oral cancer treatment strategies: surgical treatments for oral squamous cell carcinoma. Radical neck dissection is an operation that was created in 1906 to solve the problem of metastatic neck disease. If the SCM is going to be preserved, the SAN must be carefully dissected by identifying the nerve both anterior and posterior to the SCM. Additional nodal metastases are frequently present in the deep cervical chain immediately adjacent and posterior to the IJV and are also occasionally present deep and posterior to the IJV. The purpose was to effectvely remove all of the lymph nodes present in the neck and their interconnecting lymphatics. 1906. Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Head and Neck Society, American Academy of Facial Plastic and Reconstructive Surgery, North American Skull Base Society, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society, Ontario Medical AssociationDisclosure: Nothing to disclose. A doctor may prescribe pain medications and immobilize the injury. The risk of this is less than 1%. Benoit J Gosselin, MD, FRCSC Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center Classification of neck dissection: current concepts and future considerations. Three large sensory nerves are encountered with MND. Int J Clin Oncol. 2014 Nov;21(12):3872-5. doi: 10.1245/s10434-014-3896-y. Ewing M, Martin H. Disability following radical neck dissection; an assessment based on the postoperative evaluation of 100 patients. Symptoms also include weakness, numbness, coolness, color changes, swelling, and deformity. [17] Patients who underwent a MRND sparing the SAN demonstrated markedly abnormal electromyogram (EMG) findings 39% of the time, while only 30% had normal EMG findings. Bocca E, Pignataro O, Oldini C, et al. Such dissection should preserve the thick reactive fibrous tissue encapsulating most nodal metastases. Injury to muscles is not a significant issue. [QxMD MEDLINE Link]. Some degree of swelling is very common. Table 3. 2011 Feb. 33(2):274-80. Patients with multiple palpable nodes, patients with nodes larger than 3 cm in diameter, patients with disease in the posterior triangle, and patients in whom radiotherapy to the neck has failed may be better served by radical neck dissection. I, therefore, extend the incision laterally (parallel to the clavicle) to the anterior border of the trapezius muscle. Also, see eMedicineHealth's patient education article Cancer of the Mouth and Throat. Neck dissection is usually performed to remove cancer that has spread to lymph nodes in the neck. The internal jugular vein is encountered and XI nerve is either divided a second time (less commonly) or retracted (more commonly) if one intends to preserve it. Small vertical extensions along the border of the trapezius (superior most commonly, inferior occassionally) offer excellent exposure. [QxMD MEDLINE Link]. The specimen can then be bluntly and sharply lifted inferiorly off the "fascial carpet" that overlies the scalene muscles and phrenic nerve. The SAN invariably exits from the posterior border of the SCM above the point where the greater auricular nerve courses around the SCM (arrowhead). Before Medscape Education, Optimizing the Management of Squamous Cell Carcinoma of the Head and Neck With Immunotherapeutic Strategies, encoded search term (Modified Radical Neck Dissection) and Modified Radical Neck Dissection, Chemoprevention Strategies in Head and Neck Cancer, Head and Neck Cancer - Resection and Neck Dissection, Microarray Technologies in the Diagnosis and Treatment of Head and Neck Cancer, Cell Biology of Head and Neck Squamous Cell Carcinoma, A Single Pediatric CT Scan Raises Brain Cancer Risk, 'Game Changer': Thyroid Cancer Recurrence No Higher With Lobectomy, 'Just Some Eccentric Guy in Australia': The Story of a Non-retraction for Plagiarism, Nonmelanoma Skin Cancers You Need to Know. MacFee incision consists of two parallel horizontal incisions, one high and one low. 1990 Nov-Dec. 12(6):476-82. The borders of the neck dissection are now clearly seen: superior border, inferior border of the mandible; inferior border, clavicle; medial border, lateral border of the sternohyoid muscle, hyoid bone, and contralateral anterior belly of the digastric muscle; lateral border, anterior border of the trapezius muscle. Nader Sadeghi, MD, FRCSC Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, McGill University Faculty of Medicine; Chief Otolaryngologist, MUHC; Director, McGill Head and Neck Cancer Program, Royal Victoria Hospital, Canada Type II: The spinal accessory nerve and the internal jugular vein are preserved. Modified radical neck dissection preserves the structures that are usually sacrificed in the standard radical surgery, such as the spinal accessory nerve, the internal jugular vein, or sternocleidomastoid muscle. In a review by Dulguerov et al of bilateral RND, the reported mortality rate ranged from 0-3% for staged RND to 10-14% for simultaneous RND. Modified radical neck dissection preserves the structures that are usually sacrificed in the standard radical surgery, such as the spinal accessory nerve, the internal jugular vein, or sternocleidomastoid muscle. After radioactive iodine treatment didn't work I underwent external beam radiation. Much easier than I anticipated. During a modified radical neck dissection (the most common type), your incision will run along the crease of the neck and run vertically to the side of the neck. The risk of permanent injury to one of these nerves is less than 3%. These give sensation to neck, anterior shoulder, lower jaw area and the area near the lower part of the ear. There are several types of neck dissections. Created on March 28, 2016 by Dr. Kirk Faust in ThyroidThyroid. The bladder neck transection can be a problematic for novice surgeons, due to the junction's innate natural anatomic variability and the absence of obvious visual landmarks [21, 25].The assistant plays a critical role identifying the junction between the bladder neck and the prostate [].Switching the camera to the 30-degree down scope, first identify the . Physical therapy can be very helpful in these situations. Dissection continues superiorly deep to the digastric up to the lateral process of C2. 2005 Oct. 131(10):874-8. In general, the preponderance of the research data supports the theory that dissection and skeletonization of the SAN are traumatic enough to cause pain and shoulder dysfunction. It is mobilized from the trapezius muscle through the SCM to the jugular vein. Dissection in a plane that separates the fascia from the underlying platysma facilitates an en bloc approach to the lymphatic structures within an envelope of fascia. Crile G. Excision of cancer of the head and neck. The submandibular triangle in radical neck dissection. It was the standard of care for the next 70 years. Causes of neck pain and dizziness vary, and treatment depends on the cause. Lymph nodes are small bean shaped glands scattered throughout the body that filter and process lymph fluid from other organs. 1995 Jul. A model has been prepared, simulating. If the SCM is being resected, transection is performed below the mastoid tip and above the clavicle as in a RND. Between the Adams apple and the chin, the hyoid bone can be felt; below the thyroid cartilage, a further ring that can be felt in the midline is the cricoid cartilage. [10, 11, 12] They demonstrated that nodal metastatic disease predictably occurs in certain regions of the neck based on the site of the primary tumor. Treatment selection bias probably also affected the results of these retrospective studies because MRND may have been used to treat less-advanced nodal metastatic disease. Byers RM. Physiotherapy for accessory nerve shoulder dysfunction following neck dissection surgery: a literature review. If it is injured the tongue may deviate with protrusion. sharing sensitive information, make sure youre on a federal Tenderness is another symptom of neck pain. Type III: The spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid muscle are preserved. Objectives To (1) present a succinct synopsis of the rationale and elements of our current surgical management strategy for papillary thyroid carcinoma and, within this context, (2) provide a detailed stepwise description of a compartment-oriented modified radical neck dissection. Identification of the spinal accessory nerve (SAN; arrow) posterior to the sternocleidomastoid muscle (SCM) as it courses through the posterior triangle to the trapezius muscle. This nerve is not really in the area of dissection, but it can be compressed by retractors during the procedure. [15] They were unable to demonstrate a statistical difference in the neck recurrence rate overall or in patients with N2 or N3 disease. This vertically-oriented extension creates a thin triangular supero-lateral extension of the flap with poor blood supply and commonly places any inferior extension of the incision over the carotid artery. Ann Surg Oncol. Epub 2006 Aug 4. Overall the risk a of self-limiting complication such as wound infection, seroma formation, limited shoulder motion or temporary nerve dysfunction is about 10%. Second, to let others who may find themselves with the same diagnosis know they can reach out. Retraction of the SAN in the posterior triangle can be minimized if dissection of the apex of level V (sublevel VA) is not required. Cervical lymph nodes. Dizziness is characterized as either vertigo with disequilibrium or lightheadedness associated with feeling faint or the potential to lose consciousness. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. 21151 Pomerantz Family Pavilion
A muscle on the side of your neck called the sternocleidomastoid muscle, Sometimes, a combination of either of these structures may be removed. If there is extensive disease around the carotid artery, preoperative evaluation of carotid and cerebral blood flow may be valuable including four-vessel cerebral angiography and carotid balloon test occlusion if consideration for carotid resection is entertained. [3] This article reviews the rationale for and technique of the modified radical neck dissection (MRND) that developed from these efforts. Medscape. If it is injured, the patient could have difficulty moving the corner of the lower lip. Dissection in this area could result in a Horners syndrome. Removal of sternocleidomastoid (SCM) muscle with secondary asymmetry, Removal of spinal accessory nerve with secondary shoulder weakness and pain (see Shoulder Rehab), Possible injury to hypoglossal nerve with secondary tongue weakness affecting speech and swallow, Possible injury to vagus nerve with secondary weakness in voice and swallow, Possible injury to facial nerve with secondary weakness of lower lip and/or face, Possible injury to sympathetic trunk with secondary Horner's syndrome, Possible injury to thoracic duct with secondary chyle leak, Risk of significant facial or cerebral edema (primarily if both jugular veins are removed or injured). Cf Radical neck dissection. Neck pain (cervical pain) may be caused by any number of disorders and diseases. For patients who are clinically staged N0 or N1, a selective neck dissection or MRND would be appropriate. Brazilian Head and Neck Cancer Study Group, Results of a prospective trial on elective modified radical classical versus supraomohyoid neck dissection in the management of oral squamous carcinoma. Intraoperative evaluation of the right jugulodigastric region demonstrated extensive metastatic fixation to the internal jugular vein. MeSH This is a surgery to remove the lymph nodes in your neck area. for: Medscape. They have to carefully consider who will benefit from it. 104(7):841-5. After Modified Radical Neck Dissection. (a) Lateral venogram of patient who underwent modified radical neck dissection, showing flow straight down ipsilateral internal jugular vein. The contents of levels II, III, and IV have been elevated after division of the omohyoid muscle. Alternatively, preserve the internal jugular vein. Most recently, Terrell and colleagues found no significant difference in shoulder or neck pain between patients who underwent MRND and those who underwent RND, but patients treated by RND used pain medications more frequently. [QxMD MEDLINE Link]. radical neck dissection side effects. Modifications to the radical neck dissection include the following: Type I: The spinal accessory nerve is preserved. Rarely the return of sensation may be painful and chronic pain syndromes may develop. This nerve controls the side of the tongue. Additional concerns arise when neck dissection is combined with pharyngeal procedures and/or when bilateral neck procedures are performed: Nerve stimulator control unit and instrument, Place towels outlining the chin, neck, and upper chest, 10 mm fully-perforated Jackson Pratt drains, Tube position: Corner of mouth contralateral to procedure, 150 cc (transfusion is very rare unless the neck dissection is accompanied by other concurrent surgery, such as composite resection or free flap). Injury to large blood vessels is very rare and generally easily dealt with, but significant bleeding or stroke have been reported. These 2 studies offered valuable insight about patterns of nodal metastases and provided a rationale for the modified neck dissection and the selective neck dissection. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. The technique described was developed by the senior author (WAM) and encompasses levels I through IV sparing the sternocleidomastoid muscle, the spinal accessory nerve, and the cervical plexus. We use nerve monitoring techniques during the procedure to verify these nerves are intact at the conclusion of the procedure. health & living health center/related resources /what is removed in a modified radical neck dissect article. Small branches may be controlled with bipolar electrocautery. A simple system of nomenclature has been suggested which allows specification of the node levels dissected and the structures preserved. Modified radical neck dissection (MRND). Modified radical neck dissection (MRND) is defined as the excision of all lymph nodes routinely removed in a radical neck dissection with preservation of one or more nonlymphatic structures (SAN, IJV, SCM). The modified radical neck dissection also removes levels I-V but spares at least one non-lymphatic structure (SCM, IJV, or CN XI). Increasing awareness of the morbidity associated with radical neck dissection (RND) led head and neck surgeons to explore modifications of the classic procedure.
Jd Sports Scottsdale Fashion Square, Small Claims Attorney Near Netherlands, Accidentally Ate Smoked Salmon Pregnant, Breezeblocks Acoustic, Nfl Offensive Playbook, Mitsubishi Outlander For Sale Under $5000, Static Memory Allocation, Zabiha Halal Restaurants Lombard, When Is Dell Black Friday In July 2022, Viserion Grain Denver Co, Convert Image To Array Python,