In cooperation with the US Army, Georgetown University Medical Center (GUMC) deployed a teleradiology network to sites in Bosnia-Herzegovina, Hungary, and Germany in early 1996. This deployment was part of Operation Primetime III, a military project to provide state-of-the-art medical care to the 20,000 US troops stationed in Bosnia-Herzegovina.In a three-month time frame from January to April 1996, the Imaging Sciences and Information Systems (ISIS) Center at GUMC worked with the Army to design, develop, and deploy a teleradiology network for the digital storage and transmission of radiology images. This paper will discuss some of the problems associated with sending large files over communications networks with significant delays such as those introduced by satellite transmissions.Radiology images of up to 10 megabytes are acquired, stored, and transmitted over the wide area network (WAN). The WAN included leased lines from Germany to Hungary and a satellite link form Germany to Bosnia-Herzegovina. The communications links provided at least a T-1 bandwidth. The satellite link introduces a round-trip delay of approximately 500 milliseconds. This type of high bandwidth, high delay network is called a long fat network. The images are transferred across this network using the Transmission Control Protocol (TCP/IP). By modifying the TCP/IP software to increase the window size, the throughput of the satellite link can be greatly improved.