An inverse radiation treatment planning algorithm for Sensus Healthcare's Sculptura electronic brachytherapy system has been designed. The algorithm makes use of simulated annealing to optimize the conformation number (CN) of the treatment plan. The highly anisotropic dose distributions produced by the Sculptura x-ray source empower the inverse treatment planning algorithm to achieve highly conformal treatment plans for a wide range of prescribed planning target volumes. Over a set of 10 datasets the algorithm achieved an average CN of 0.79 ± 0.08 and an average gamma passing rate of 0.90 ± 0.10 at 5%/5 mm. A regularization term that encouraged short treatment plans was used, and it was found that the total treatment time could be reduced by 20% with only a nominal reduction in the CN and gamma passing rate. It was also found that downsampling the voxelized volume (from 320 to 64 voxels) prior to optimization resulted in a 150× speedup in the optimization time (from 2 + minutes to < 1 s) without affecting the quality of the treatment plan.