In this paper, we report a direct-conversion-type X-ray sensor composed of trench-structured silicon photodiodes, which achieves a high X-ray-tocurrent conversion efficiency under side X-ray irradiation. The silicon X-ray sensor with a length of 22.6 mm and a trench depth of 300 µm was fabricated using a single-poly single-metal 0.35 µm process. X-rays with a tube voltage of 80 kV were irradiated along the trench photodiode from the side of the test chip. The theoretical limit of X-ray-to-current conversion efficiency of 83.8% was achieved at a low reverse bias voltage of 25 V. The X-ray-to-electrical signal conversion efficiency of conventional indirect-conversion-type X-ray sensors is about 10%. Therefore, the developed sensor has a conversion efficiency that is about eight times higher than that of conventional sensors. It is expected that the developed X-ray sensor will be able to markedly lower the radiation dose required for X-ray diagnoses.