I'm obviously a confused idiot. If an image has alt-text I never see it, but isn't it always read by a screen reader?
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The alt attribute provides alternative information for an image if a user for some reason cannot view it (because of slow connection, an error in the src attribute, or if the user uses a screen reader).
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https://www.w3schools.com/TAGS/att_alt.asp
As an aside why didn't the original 1999 pre-epub2 (or epub2) implement the simple client side image map? Though limited use except for "plot your own adventure" type novels.
I've not read these links on the subject.
https://www.w3.org/WAI/alt/
I always put alt text on any image needing it. I'd not put it on a QR code for a URL that has the QR code URL in text exactly visible.
I test TTS on Pocketbook on Android.