That is a good question, and I will make a note to find a solution for that. Or at least a good answer why that is not possible. I am currently thinking about relative positioning and if that might pose a problem...
For the moment, this workaround should work:
$page = pgContent('Test');
addToBox(
    $page,
    box(
        image('skala.png'),
        ['x' => 60, 'y' => 40, 'width' => 100]
    )
);
However, if you are working with floating elements and relative positions, then it won't probably solve your problem?!
Update
 After a detailed analysis, I can confirm that there is a systemtic limitation that disallows for using settings within addToBox().
Such settings can only be applied to the elements that are added. When using add() with settings, a box() will implicitly be added around the content. This box will then carry the settings. Therefore the above mentioned workaround is one official solution. The other is even more simple: Many elements can carry settings themselves.
$page = pgContent('Test');
addToBox(
    $page,
    image('skala.png', [
      'x' => 60,
      'y' => 40,
      'width' => 100
    ])
);