Using an image captcha is a very bad idea (Do you know anyone who is blind? Ask them what their opinion is on this matter).
There are alternatives, I've just put one on the contact form of my own site. Basically, you have an array of text values, so 1 is 'the number of heads you have', etc. The resulting mathemtical string would be something like "the number of heads you have * the highest prime below ten". This is displayed to the user, and a hidden field in the form contains an MD5 hash of this string and some other bit of information (timestamp, whatever) which is stored on your server somewhere (DB, session, etc) alongside the result of that equation.
When the user fills in the form, the hash is compared with what is stored on the server to get the actual result of the equation, and this is then compared with what the user sent. So at no time does the user ever see the raw answer, it's fully accessible to visually impaired, and your form is still protected. Also, it's a lot less processor intensive than any image functions.
For a bit of variety, you could have several strings which equate to the same number, to avoid any spam bot from "learning" your values (if you have enough it increases the effort a spammer has to go to, and beyond a certain point it's not worth their time)