This topical review provides an up-to-date overview of the theoretical and practical aspects of therapeutic kilovoltage x-ray beam dosimetry. Kilovoltage x-ray beams have the property that the maximum dose occurs very close to the surface and thus, they are predominantly used in the treatment of skin cancers but also have applications for the treatment of other cancers. In addition, kilovoltage x-ray beams are used in intra operative units, within animal irradiators and in on-board imagers on linear accelerators and kilovoltage dosimetry is important in these applications as well. This review covers both reference and relative dosimetry of kilovoltage x-ray beams and provides recommendations for clinical measurements based on the literature to date. In particular, practical aspects for the selection of dosimeter and phantom material are reviewed to provide suitable advice for medical physicists. An overview is also presented of dosimeters other than ionization chambers which can be used for both relative and in vivo dosimetry. Finally, issues related to the treatment planning and the use of Monte Carlo codes for solving radiation transport problems in kilovoltage x-ray beams are presented.