Purpose: Measurement of actual dose delivered during radiotherapy treatment aids in checking the accuracy of dose delivered to the patient. In this study, a couch-based real time dosimetric device has been proposed to measure the exit or entrance dose to a patient during external beam radiotherapy. The utility and feasibility of such a device using a 2D array of diodes has been demonstrated. Methods: Two MAPCHECK devices: MAPCHECK (1175) and MAPCHECK 2 (both SunNuclear) were embedded in a foam block in the treatment couch of a Varian 21iX linear accelerator. The angular dependence of the detector response for both devices was studied before implementing the MAPCHECKs for experimental purposes. An Alderson Rando head phantom was scanned with the MAPCHECK and MAPCHECK 2 devices separately and four different treatment plans were generated with target volumes at three different positions simulating typical clinical situations. The analytical anisotropic algorithm (AAA) was used to compute the doses in an Eclipse treatment planning system (Varian Medical Systems). The Rando phantom with the MAPCHECK device was exposed in Clinac 21iX linear accelerator. The measured dose distribution was compared with the calculated dose distribution to check for the accuracy in dose delivery. Results: Measured and computed dose distribution were found to agree with more than 93 of pixels passing at 3 and 3 mm gamma criteria for all the treatment plans. The couch-based real time dosimetry system may also be applied for noncoplanar beams where electronic portal imaging device (EPID) is not practical to measure the dose. Other advantages include checking the beam stability during the patient treatment, performing routine morning quality assurance (QA) tests in the linear accelerator, and to perform pretreatment verification of intensity modulated radiation therapy (IMRT). One of the drawbacks of this system is that it cannot be used for measuring the dose at 90 or 270 gantry angles. Conclusions: This preliminary study shows that a 2D array of detectors may be used as part of the treatment couch for real time patient dosimetry in studying the dose delivered to the patient in real time and also for performing routine quality assurance. © 2011 American Association of Physicists in Medicine.