I'll try to answer your questions in order:
1) Check the gauge of the perfs for consistency. I graphically take perfs from one side and line them up with the opposite side (top vs bottom, or left vs. right.) I usually try to match the first 3-4 perf holes as best I can, then look at the other end. If the perfs aren't perfectly matched up at the other side, the gauge is different on one of the sides and the perfs on one of those sides aren't genuine.
IMO, no physical gauge (Kiusalas, etc.) can match the accuracy of this test when done on a high-resolution scan. I can probably detect gauge differences of 0.01 - impossible to see slight differences like that lining perfs up on a Kiusalas.
Also, the sides need to be exactly parallel. If you line up those first 3-4 holes and form perfect circles and you end up with ovals at the other end (even if the gauge is exact,) then the sides are not parallel and one of them is reperfed.
2) Perfectly round & clean-cut perfs are almost always fake. Depending on the quality of the scan, you may be able to see pressure ridges (a characteristic of genuine perfs - lack of them is a red flag.)
3) If the gauge doesn't match, or the sides aren't parallel, the test is near 100% accurate at detecting a reperf, although it won't tell you which side has been altered.
There are expert reperfs out there and the gauge of each side will match precisely and the sides will be perfectly parallel. That's why if it "passes" the Srail test, you still have work to do. You need to look at the shape, cut, pressure ridges, etc. and confirm the perfs are genuine (I use a 25x loupe and at that point would use something like a Kiusalas to confirm the gauge is actually correct for issue.)
In other words, the test can pretty conclusively tell you perfs on one side are fake, but it CANNOT (by itself) tell you the perfs are genuine, only that they MAY be.
4) One (of many) caveats: In order to do graphical manipulations like the "Srail test," the stamp must have been scanned. You can't do these tests from photographs (and lots of
ebay lots are photographed.) Also, my comments about perf cut, shape, etc. apply mainly to regularly-issued early USA stamps. Genuine perfs for modern issues, other countries, etc., may have different characteristics.
Hope this helps.