Background: A significant portion of cryptogenic stroke is hypothesized to be secondary to cardiac embolism. However, transthoracic echocardiogram is usually delayed after stroke and more detailed cardiac imaging not routinely done. Aims: This study aimed to determine whether non-ECG gated cardiac CT angiography (cCTA) during hyperacute stroke would provide diagnostic quality images and act as an adjunct modality of cardiac imaging to detect sources of emboli. Methods: In this single-centre prospective cohort study, modified Code Stroke imaging was implemented with a 64-slice CT scanner, where the longitudinal axis of CT angiography was extended from the carina to the diaphragm. Primary outcome of image quality, recruitment feasibility, impact on hyperacute time metrics and additional radiation dose were assessed. Secondary outcomes consisted of detection of high-risk cardiac sources of embolism, mediastinal or lung pathology and impact on etiologic classification. Results: One hundred and twenty eligible patients were enrolled, of which 105 (87.5%) had good/moderate quality images for motion artifact and 119 (99.2%) for contrast opacification. Total CT-time, door-to-needle time and door-to-groin puncture time were unchanged with the addition of cCTA. Eighty-nine patients received a final diagnosis of ischemic stroke, of which 12/89 (13.5%) had high-risk cardioembolic findings on cCTA. Incidental findings, such as pulmonary embolism (7/89, 7.9%) and malignancy (6/89, 6.7%), were observed. cCTA led to changes in management for 19/120 (15.8%) of all patients, and reclassification of stroke etiology for 8/89 (9%) of patients. Conclusions: Non- ECG-gated cCTA can be feasibly incorporated into Code Stroke and provide diagnostic quality images without delays in hyperacute time metrics. It can detect high-risk cardiac sources, and other findings impacting patient care. This may help reclassify a subset of cryptogenic stroke cases and improve secondary prevention. Data Availability: Data from this study is available and can be accessed upon request.

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Conclusions: When IR performance of bone marrow biopsy is offered, it can overwhelm a practice. Fluoroscopic guidance compared with blind techniques improves the diagnostic rate only in morbidly obese patients. There is no statistically significant difference between the diagnostic rate of bedside vs image-guided biopsies in non-obese patients. Therefore, we propose clinical criteria prior to accepting requests for these biopsies including BMI cutoffs (>40 kg/m 2 ) or prior failed bedside biopsy.