A miniature fiber-optic dosimeter (FOD) system was fabricated using a plastic scintillating fiber, a plastic optical fiber, and a multi-pixel photon counter to measure real-time entrance surface dose (ESD) during radiation diagnosis. Under varying exposure parameters of a digital radiography (DR) system, we measured the scintillating light related to the ESD using the sensing probe of the FOD, which was placed at the center of the beam field on an anthropomorphic thorax phantom. Also, we obtained DR images using a flat panel detector of the DR system to evaluate the effects of the dosimeter on image artifacts during posteroanterior (PA) chest radiography. From the experimental results, the scintillation output signals of the FOD were similar to the ESDs including backscatter simultaneously obtained using a semiconductor dosimeter. We demonstrated that the proposed miniature FOD can be used to measure real-time ESDs with minimization of DR image artifacts in the X-ray energy range of diagnostic radiology.