Web Standards & Policies

In general, the TUSM website uses Associated Press (AP) style. TUSM administration, faculty and students have access to the Online AP Style Book via the Hirsh Health Sciences Library.

All text and graphics are copyright of Tufts/TUSM unless otherwise indicated and should not be reproduced without written permission from an appropriate representative.

Follow these best practices to ensure that people will have an easier time finding information on the website and improve search engine optimization.


All images should include an alternative (alt) attribute. A well-written alt attribute (sometimes called the alt tag) will descriptive text that clarifies the context of the image with regard to page content, if any.

For example, an image may represent an action (or include a link) a viewer is being asked to take, such as a photo of a student with the words "Apply Now" as part of the photo. The alt tag for this image might say "A photo of a smiling female medical student with a link to the secondary medical application at http://www.xxx.xxx".

Alt (short for alternative) text is important for two reasons:

  1. First, it helps to ensure our web code is in compliance with federal guidelines for the American Disabilities Act. How? People with impaired vision sometimes rely on software that reads web pages. Many web pages are full of images. If those images have no text associated with them, the software may skip over them or recognize them as an image, but not understand their significance. Since images may contain important contextual information, a vision-impaired user may not get the same experience as a sighted user if alt tags are not used properly. There is much more to the accessibility of an image than just its alt text. There are many additional accessibility principles and techniques regarding images.

  2. Second, alt tags help search engines index pages. Like software for vision-impaired folks, search engines rely on text to understand and categorize page rankings. Clear, readable alt tags can help improve page rankings. It's yet another opportunity to include important wording that could influence how a page is indexed.

Most people know that you need to provide alternative text for images. There is much more to the accessibility of an image than just its alt text. There are many additional accessibility principles and techniques regarding images.

Accessible PDFs

First, it is important to distinguish between Adobe, Acrobat, and PDF. These terms are often used interchangeably, but they are not the same.
  • Adobe is a company; they are the creators of Acrobat.
  • Acrobat is a tool for creating, editing and viewing PDF files.
  • PDF is a format or type of document. It stands for Portable Document Format. The PDF format was created by Adobe.

The terms Adobe, Acrobat, and PDF are related in the same way as Microsoft, Word, and doc. 

When people talk about "accessible" PDF files, they usually are referring to "tagged" PDF files, even though there is more to an accessible PDF than tags. PDF Tags provide a hidden structured, textual representation of the PDF content that is presented to screen readers. They exist for accessibility purposes only and have no visible effect on the PDF file. HTML tags and PDF tags often use similar tag names (e.g., both have tags named h1) and organization structures, but they really are quite different. If you are comfortable with HTML, you will probably have an easier time creating and editing tagged PDF files.

  1. Converting Documents to PDF – PDF files are not typically created in Acrobat. They are usually created in another program and converted to PDF. There are dozens or probably hundreds of programs that can create PDF files, but very few of them produce tagged PDF files. If you are using Microsoft Word or PowerPoint, OpenOffice.org Writer, or Adobe tools such as InDesign, you can often create accessible, tagged PDF files without opening Acrobat. Of course, the accessibility of the PDF depends on the accessibility of the original document. The following instructions can also be used to convert PowerPoint files to PDF.

  2. Acrobat and Accessibility – Although you can create accessible PDF files in several programs, Adobe Acrobat Professional is required to evaluate, repair, and enhance the accessibility of existing PDF files.
    • Tags Pane – The Tags pane allows you to view, reorder, rename, modify, delete, and create tags. Many of these actions can be completed more easily using the TouchUp Reading Order tool, but there are some actions that can only be accomplished in the Tags pane.
    • TouchUp Reading Order – The TouchUp Reading Order (or TURO) tool allows a user to add and edit many common PDF tags, and to view the content order of elements on the page. Although it can speed up the tagging process, it does not take the place of the other tools mentioned previously. Certain tags, such as lists, are only available in the Tags pane.
    • Other Tools & Features

  3. Accessible Forms in Acrobat XI – Compared to HTML, PDF forms have some inherent accessibility limitations. There is no real way to associate the visible text label with the form field, but there is a way to provide a text description that will be read to a screen reader while navigating through the PDF. In addition to the accessibility principles outlined in the previous page of this article, the following four steps are required to ensure the accessibility of a PDF form: