In some examination items, visual elements such as graphs, charts, tables, diagrams, and infographics are used to convey information. For candidates who receive accommodations to use text-to-speech software during an examination, these visual elements can create barriers to accessing and interpreting item content. In this snapshot session, participants will learn how to develop examination items that meet accessibility guidelines while ensuring that candidates using text-to-speech software have an equivalent opportunity to interpret and answer multiple-choice questions. We will explore best practices for creating accessible content, including recommended item structures, language considerations, and approaches to conveying information through visual elements.