Introduction: Diagnostic reference levels (DRL) of procedures involving ionizing radiation are important tools for optimizing radiation doses delivered to patients and to identify cases where the levels of dose are unusually high. This is very important for pediatric patients undergoing fluoroscopic examinations, as these examinations can be associated with a high radiation dose. Material and Methods: Pediatrics fluoroscopic studies performed at Maternity and Children Hospitals in Makah city was conducted on 140 patient Children ranging in age from (1 to 14 years) analyzed to determine range, mean, 75th percentiles of Dose–Area Product (DAP) undergoing X-ray Fluoroscopy examination to evaluate the diagnostic and measure Total Effective dose (msv), and Total Entrance Dose (mGy.cm2). This data is automatically collected from DF by the structured sent by the imaging network’s to the software (DICOM, RIS, HIS, and Dose watch. Results: were obtained Result Comparing the dose (DAP, and ESR) with the (NPDD-IAEA-ICRP) depend on range or median, all radiation doses for pediatric are within the limit. Conclusion: Diagnostic reference levels are recommended as an optimization tool for radiation dose assessment in medical imaging procedures involving the utilization of radiation. So can be divided the optimization for reducing doses to exposure setting and exposure protocol.