Image-clicking Q&A captcha alternative that is customisable? I'm looking for a simple way to spam-proof new user registration that works along the lines of Confident Captcha (demo, module page).

These work by asking a simple question, then the user clicks on the appropriate image. Very easy for humans, very difficult for bots. 



My problem with the Confident Captcha system, however, is that it relies on a 3rd party plugin which isn't customisable. I want to be able to set the questions, images and widget display to match the content and theme of my site.



Note: I'm aware that this approach has accessibility issues for blind or partially sited users. For my project, this can be dealt with manually and isn't an issue, but bonus points for options that have a built-in accessible alternative.

Also, bonus points for options that don't depend on a 3rd-party service.



One related module worth mentioning:


Captcha Questions - totally customisable, but appears to be text only requiring users to do more typing.
Here's one option I've found - Fancy captcha - based on a library which uses icons. Looks like a simpler stack than Confident Captcha, but no stable release on D7.



Pros:


Based on a re-purposed library installed locally, so you can modify the files
Doesn't require a third-party service


Cons:


No stable non-dev release yet (at time of posting)
I can't see any evidence of an accessible fallback for screen readers etc