In order to make sure everyone is writing alt text in a similar way for similar images, keep a style sheet which indicates how to handle each situation. This is a living document that grows and changes as the project progresses.

1. Translation Exercise (example) "Translation exercise with 14 items on page 61. Provide the correct term for the highlighted
text."
Electronic Medical Records (example).
NOTE: Not all Medical Records have questions following them.
"Electronic medical record on page 260 for Tyson Bernard related to the three questions
below. The record concerns a transrectal ultrasound of the prostate."
Case Study null
Focus On... null
Figure Parts Part A, or Part B (not Part "A", or Part "B")
Icons These will be handled on a global basis, do not create alt text at the chapter level.
Periods Please use a period at the end of each alt text regardless of whether it's a complete
sentence or not. (This allows the typesetter and the listener to know there is nothing
missing.)
Text formatting There is no bold, italic, etc. in alt text. Do not use text formatting to convey meaning.
Labels: repeated in text
(example)
If they are repeated in the main text then they do not need to be in the alt text. See figure 1-
4, page 6. Add the phrase "as described in the text" as needed.
"Simple drawing of the body, calling out each of the six combining forms, each with its own
pie-shaped word wheel that repeats the six suffixes."
Style Notes
Note: Examples appear in quotes, e.g., "This is an example."

2. Labels: not repeated in text If the labels do not appear in the main text then they need to be in the alt text. They should appear in a logical
manner, e.g., top to bottom, left to right, etc. See figure 1-6, page 11.
Labels: partially repeated in text If not all labels appear in the main text then all labels should be in the alt text. They should appear in a logical
manner, e.g., top to bottom, left to right, etc. See figure 2-6.
Word diagrams
(example)
If the information does not appear in the text, it needs to be in the alt text. See Figure 1-3, page 5.
"Text-only diagram clarifying the four steps of the CARD method with red-blue color-coding to show the reversal
occurring. The example is Glossitis. Check: divide word parts into gloss and itis. Assign meanings to the word parts:
tongue and inflammation. Reverse the word order: inflammation and tongue. Once the reversal is complete, Define
the word: inflammation of the tongue.”
Figure types The type of image is often important to medical texts. In general, identify figure types as a drawing, cutaway
drawing, labeled drawing, diagram, photograph, x-ray, MRI, ultrasound, microscopic image, or tissue slide.

3. Drawings versus diagrams It's a continuum, but in general drawings are representational, diagrams are more abstract (e.g., a Venn
diagram, a process, a pyramid, etc.)
Page numbers
(example)
The alt text should only refer to a page number if there is a large amount of information that might require a
third party to create a transcript.
"Electronic medical record on page 195 for Regina Kao related to the four questions below. The medical
record concerns a colonscopy procedure and a diagnosis of diverticula."
Position of objects in a drawing Sometimes the position of an object is critical to the understanding of the image. In figure 6-20, it is important
to note that the dialysate bag is above the patient and the drainage bag is below the patient.
Separate files for image parts If you have an image file for Part A and a separate one for Part B, both files need their own alt text because a
screen reader will recognize them as individual images, not part of a whole.
Do not repeat the figure legend in the alt text. Example: Fig. 3-15 alt text shouldn't list the labels Kyphosis, Lordosis, and Scoliosis because they're in the
legend.
Use non-gender specific language when describing a person unless
gender is relevant to the issue.
For example, use "patient" instead of "woman." For a patient receiving dialysis, gender is not relevant. For a
patient receiving a mammogram, it is relevant.
For figures with multiple images, assume that the figure will appear as
only one image to the screen reader.
For example, a drawing with an enlarged portion called out.

4. Follow the style of the text when referring to patients and caregivers. Patient versus Client. Caregiver versus Practitioner.
Icons Alert icon = "alert"
Evolve icon = "Evolve"
Exercise icon = null
Stage of life icon = null
Figure legends describing image When the figure legend does a good job of describing the image, there is no need to repeat that information in the alt tag. Instead, use
the alt tag to address any additional information in the image. (See Figure 12-1 on pg. 441.)
Labelling activities For consistency, these should be handled like so: “Anatomy exercise with X items on page X. Enter the correct term in the place
provided to label the <describe what’s being labelled>. Refer to Figure X on page X.”).
Articles (a, an, the) Omit these if possible.
Acronyms If it is read as written, leave it as-is (e.g., “IV” = IV).
If reading it as written would introduce confusion, then spell it out (e.g., “CABG” = coronary artery bypass graft).
Publisher abbreviations (p, pg, pp, num, fig, tab, etc.) Always spell these out.
Anatomic direction (e.g., distal, proximal, prone, supine, etc.) For Shiland, please use the terms from the text in Chapter 2.
For more-advanced texts, use the anatomical terms found here:
https://en.wikipedia.org/wiki/Anatomical_terms_of_location

5. Arrows When these are pointing at something, describe what they are pointing at, not what direction that are
pointing in (e.g., “Arrow pointing at apex of heart.” not “Arrow pointing left.”)
Exception: maps and other uses that are directional. In this case, the direction is important (e.g.,
Arrow pointing West indicates Westward migration patterns.)
Patient vs. Client Use the term that best matches the text. (Note that this can vary within a book, so use what the
chapter you are in uses.)
Cross-section vs cutaway Cutaway: surface elements of a 3D model are selectively removed to reveal the inner parts. Example
is Figure 6-2
Cross section: surface or shape shape that is or would be exposed by making a straight cut through
something especially at right angles to an axis. Example: Figure 6-3 is cross-section.