The O-arm is a cone beam imaging system designed primarily to support orthopedic surgery and is also used for image-guided and vascular surgery. Using a gantry that can be opened or closed, the O-arm can function as a 2-dimensional (2D) fluoroscopy device orcollect 3-dimensional (3D) volumetric imaging data like a CT system. Clinical applications of the O-arm in spine surgical procedures, assessment of pedicle screw position, and kyphoplasty procedures show that the O-arm 3D mode provides enhanced imaging information compared to radiographs or fluoroscopy alone. In this study, the image quality of an O-arm system was quantitatively evaluated. A 20 cm diameter CATPHAN 424 phantom was scanned using the pre-programmed head protocols: small/medium (120 kVp, 100 mAs), large (120 kVp, 128 mAs), and extra-large (120 kVp, 160 mAs) in 3D mode. High resolution reconstruction mode (512x512x0.83 mm) was used to reconstruct images for the analysis of low and high contrast resolution, and noise power spectrum. MTF was measured using the point spread function. The results show that the O-arm image is uniform but with a noise pattern which cannot be removed by simply increasing the mAs. The high contrast resolution of the O-arm system was approximately 9 lp/cm. The system has a 10% MTF at 0.45 mm. The low-contrast resolution cannot be decided due to the noise pattern. For surgery where locations of a structure are emphasized over a survey of all image details, the image quality of the O-arm is well accepted clinically.