Modern radiotherapy uses highly conformai dose distributions and therefore relies on daily image guidance for accurate patient positioning. Kilovoltage cone beam CT is one technique that is routinely used for patient set-up and results in a high dose to the patient relative to planar imaging techniques. This study uses an Elekta Synergy linac equipped with XVI cone beam CT to investigate the impact of various imaging parameters on dose and image quality. Dose and image quality are assessed as functions of x-ray tube voltage, tube current and the number of projections in the scan. In each case, the dose measurements confirm that as each parameter increases the dose increases. The assessment of high contrast resolution shows little dependence on changes to the image technique. However, low contrast visibility suggests a trade off between dose and image quality. Particularly for changes in tube potential, the dose increases much faster as a function of voltage than the corresponding increase in low contrast image quality. This suggests using moderate values of the peak tube voltage (100 – 120 kVp) since higher values result in significant dose increases with little gain in image quality. Measurements also indicate that increasing tube current achieves the greatest degree of improvement in the low contrast visibility. The results of this study highlight the need to establish careful imaging protocols to limit dose to the patient and to limit changes to the imaging parameters to those cases where there is a clear clinical requirement for improved image quality.