An X-ray image diagnostic apparatus is provided with an X-ray irradiation unit configured to perform irradiation with X-rays; a detection unit configured to detect the X-rays; a top table configured to be movable and allow a test object to be mounted; a position information acquisition unit configured to acquire first relative position information representing a relative position of the X-ray irradiation unit with respect to a position of the top table, and second relative position information representing a relative position of the detection unit with respect to the position of the top table, as clinical position information; and a drive control unit configured to drive the X-ray irradiation unit and the detection unit, based on displacement information representing a displacement of the position of the top table and the clinical position information.