A systematic study of the PTW microDiamond (MD) output factors (OF) is reported, aimed at clarifying its response in small fields and investigating its suitability for small field reference dosimetry. Ten MDs were calibrated under 60Co irradiation. OF measurements were performed in 6 MV photon beams by a CyberKnife M6, a Varian DHX and an Elekta Synergy linacs. Two PTW silicon diodes E (Si-D) were used for comparison. The results obtained by the MDs were evaluated in terms of absorbed dose to water determination in reference conditions and OF measurements, and compared to the results reported in the recent literature. To this purpose, the Monte Carlo (MC) beam-quality correction factor, [Formula: see text], was calculated for the MD, and the small field output correction factors, [Formula: see text], were calculated for both the MD and the Si-D by two different research groups. An empirical function was also derived, providing output correction factors within 0.5% from the MC values calculated for all of the three linacs. A high reproducibility of the dosimetric properties was observed among the ten MDs. The experimental [Formula: see text] values are in agreement within 1% with the MC calculated ones. Output correction factors within +0.7% and -1.4% were obtained down to field sizes as narrow as 5 mm. The resulting MD and Si-D field factors are in agreement within 0.2% in the case of CyberKnife measurements and 1.6% in the other cases. This latter higher spread of the data was demonstrated to be due to a lower reproducibility of small beam sizes defined by jaws or multi leaf collimators. The results of the present study demonstrate the reproducibility of the MD response and provide a validation of the MC modelling of this device. In principle, accurate reference dosimetry is thus feasible by using the microDiamond dosimeter for field sizes down to 5 mm.