Objective To investigate the application value of optical surface monitoring systems (OSMS) in head tumor radiotherapy and to evaluate their impact on positioning accuracy, treatment efficiency, and patient experience. Methods A retrospective analysis was conducted on the clinical data of 80 patients who underwent radiotherapy for head tumors at The First Affiliated Hospital of Bengbu Medical University from January 2022 to December 2024. The patients were divided into an observation group (OSMS+CBCT, n=40) and a control group (traditional laser positioning+CBCT, n=40) based on different positioning methods. Differences between the two groups were compared in terms of three-dimensional positioning error, treatment preparation time, repositioning rate, and patient satisfaction. Results The average positioning errors in the X, Y and Z directions for the observation group were (0.78±0.33) mm, (0.85±0.30) mm and (0.92 ±0.36) mm, respectively. These were all significantly better than the corresponding values for the control group (P<0.05). Patient satisfaction scores in the observation group were significantly higher than those in the control group [(94.00±3.46) points vs. (85.80±5.87) points, P<0.05)]. The observation group also had shorter treatment preparation times [(6.23±1.07) minutes vs. (9.65±1.43) minutes, P<0.05)], a higher satisfaction rate (92.50% vs. 75.00%, P<0.05) and a lower repositioning rate (10.00% vs. 32.50%, P<0.05). Conclusion The OSMS can effectively improve the positioning accuracy of head tumors radiotherapy, optimize the treatment process, improve patient experience, and have good clinical practicality and promotion prospects.