I have had a lot of success just using alt tags and anchor text - I have not used title tags or LONGDESC or anything like that. I agree that you can overdo it with keywords. But it is not true that
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"alt tags are not displayed to search engines and likely any scoring of keywords within this tag would be minimalistic....."
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for an example:-
Google Image Search for 'Omagh Ireland Wallpaper'
'Ireland Wallpaper' was in the alt tag for this image but not the anchor text.