Network latency and operator performance in teleradiology applications

Teleradiology applications often use an interactive conferencing mode with remote control mouse pointers. When a telephone is used for voice communication, latencies of the data network can create a temporal discrepancy between the position of the mouse pointer and the verbal communication. To assess the effects of this dissociation, we examined the performance of 5 test persons carrying out simple teleradiology tasks under varying simulated network conditions. When the network latency exceeded 400 milliseconds, the performance of the test persons dropped, and an increasing number of errors were made. This effect was the same for constant latencies, which can occur on the network path, and for variable delays caused by the Nagle algorithm, an internal buffering scheme used by the TCP/IP protocol. Because the Nagle algorithm used in typical TCP/IP implementations causes a latency of about 300 milliseconds even before a data packet is sent, any additional latency in the network of 100 milliseconds or more will result in a decreased operator performance in teleradiology applications. These conditions frequently occur on the public Internet or on overseas connections. For optimal performance, the authors recommend bypassing the Nagle algorithm in teleradiology applications.