Skin eBx®

Why Skin eBx?

The Xoft® Electronic Brachytherapy (eBx®) System® enables the clinician to administer surface brachytherapy without the use of a radioactive isotope or a megavoltage linear accelerator, making surface treatments more accessible at locations where no vault exists and eliminating treatment delays by expanding access to radiation therapy.

eBx simplifies the surface radiation process with improved targeting of the tumor site using a direct contact applicator and a flexible clamp. The lightweight surface applicator (less than 150g) can be precisely oriented to the desired location on the patient (target lesion). With the reduced shielding requirement of eBx, the physician can remain near the patient. Furthermore, faster dose fall-off of the low-energy miniaturized X-ray source minimizes exposure to healthy adjacent tissues.

Technology Comparison

  • Targeted non-melanoma skin cancer (NMSC) treatment results in excellent (>90%) cosmesis¹
  • Painless, non-invasive option for select patients
  • Ideal for challenging anatomic locations

Compared to electron beam therapy, the Xoft System surface brachytherapy system allows a more precise set-up with continuous monitoring, which might allow smaller margins with smaller treatment fields, potentially leading to fewer treatments of higher doses with similar cosmetic results. The delivered field with the Xoft System source has sharp fall-off edges (the 80–20 penumbral transition width is under 3 mm versus 10–12 mm of MeV electrons)1, which allows field sizes as small as 1 cm in diameter. The applicator has been designed to deliver homogenous dose over 90% of the target area. With the ability to plan the field accurately within 1 mm of the desired treatment site, a smaller area can be used to deliver the treatment dose. A target area between 1 cm and 5 cm in diameter over a range of treatments allows for optimal dose application. With the combination of ease of placement, precision of dose delivery and small applicator size, almost any externally accessible area on the body can be treated (for example buccal mucosa of the oral cavity)2.

Treating with eBx

eBx is administered under the direction of a supervising physician. In cooperation with the dermatologist, the radiation oncologist will determine the amount of radiation needed and the physicist will ensure that the radiation is delivered as prescribed. eBx can be delivered on an outpatient basis in a room with reduced shielding requirements. Treatment regimen and prescription depend on tumor size, type, depth, patient age, prior treatments and other criteria. During radiation therapy, the surface applicator is connected to the Xoft System Controller. A miniaturized X-ray source is placed in the applicator and energized to deliver radiation for a few minutes. At the completion of the treatment, the X-ray source is turned off.

Xoft SMART Skin eBx

The Xoft Streamlined Module for Advanced Radiation Therapy (SMART) platform is an adaptive, patient-centric solution to improve workflow efficiency, flexibility, safety and security of a skin electronic brachytherapy (eBx) program.

The Xoft SMART platform offers clinical practices an automated and efficient method for managing operational aspects of a Xoft Skin eBx program. This comprehensive platform provides all members of the care team with a collaborative environment in which to manage patient workflow.

The easy-to-use, flexible design of the SMART platform may be customized into any clinical practice. This unique, end-to end subscription provides practices with the next generation of hardware and software designed to facilitate unprecedented clinical collaboration and unparalleled quality of care – all from the market leader in electronic brachytherapy.

  • Wi-Fi Enhancements
    Includes new Wi-Fi enabled Xoft System powered by Axxent Hub cloud software. Eliminates need to exchange and manage patient treatment data.
  • Quality Review
    Offers care team members the ability to monitor and review patient treatments improving the quality of patient care.
  • Clinical Efficiency
    Standardizes patient safety checks through added displays to verify and validate treatment plans. Quickly recalculate patient treatment times and easily perform second checks.
  • Information Privacy
    Eliminates need for USB drive and barcode scanner to import patient and treatment data.
  • Secure Communication
    Facilitates care team communication and collaboration through secure messaging and notifications.
  • Document Management
    Streamlines documentation with customized physician note templates and task manager viewing window.
  • Metrics and Reporting
    Real-time reporting manages superbills, financial and clinical operations


  • Axxent SPX Controller:
    Specifically designed and wirelessly optimized for surface treatments, this highly mobile, easily transported unit features a streamlined design for improved patient positioning and comfort. Learn more about the Axxent SPX Controller.
  • Axxent X-ray Source:
    Proprietary isotope-free source technology allows surface treatments in virtually any setting with minimal shielding. The fast dose fall-off of the 50 kV source minimizes exposure to adjacent healthy tissues and organs and allows medical personnel to remain in the room with the patient.
  • Axxent Surface Applicators:
    With sizes ranging from 10mm to 50mm, Xoft offers a wide range of applicators providing clinicians with maximum flexibility in treating a variety of lesion sizes. In addition, the proprietary flattening filter at the apex of the cone ensures even dose distribution across the lesion surface. Learn more about the Axxent Surface Applicators.


  • Axxent Hub:
    Enhanced, cloud-based software allows clinicians to manage patient volumes and treatments, organize patient dose prescriptions for multiple lesions, and develop best practices, policies and procedures for a skin eBx program.

    The Axxent Hub is a repository that enables documentation, quality assurance and treatment management to improve efficiency and reduce risk of systematic errors in patient care. The Axxent Hub provides real-time performance metrics and reports based on patient treatment data. Superbills and daily Charge Capture Summary Reports streamline billing and office workflow.

Facts About Skin Indications

One in six Americans develops skin cancer at some point with over a million cases annually in the U.S.3,4 Most patients are diagnosed with non-melanoma skin cancer (NMSC) with basal cell carcinoma being the most common in 80% and squamous cell carcinoma representing 20%. The majority of lesions are located on sun-exposed areas like face, backs of hands and neck. According to the NCCN guidelines5 radiation therapy is a treatment option for primary NMSC treatment or secondary in case of positive margins post-surgical. Keloid scarring is another indication that is most suitable for surface brachytherapy. Surgical excision of keloid formation is usually only effective 20–50% of the time with surgery alone. With combined surgery and radiation therapy, the treatment is successful over 80% of the time.6

  1. Perez CA, Brady LW. Principles and Practice of Radiation Oncology. Third edition. Lippincott, Williams & Wilkins: 1998.
  2. Sabbas AM, et al. HDR Brachytherapy with Surface Applicators: Technical Considerations and Dosimetry. Technology in Cancer Research & Treatment 2004. Vol 3(3); 259–267.
  3. National Cancer Institute 2008:
  4. American Cancer Society, Cancer Facts and Figures 2008:
  5. National Comprehensive Cancer Network:
  6. Lawrence WT. In search of the optimal treatment of keloids: report of a series and a review of the literature. Ann Plast Surg 1991;27:164–78.


©2018 Xoft®, a subsidiary of iCAD, Inc. All rights reserved. Xoft, the Xoft logo, Axxent, Electronic Brachytherapy System and eBx are registered trademarks of iCAD, Inc.  Reproduction of any of the material contained herein in any format or media without the express written permission of iCAD, Inc. is prohibited.