I ran in to this frequently. I tried the usual...verifying game files through Steam, defragging the game files, all the general Steam and PC troubleshooting you would go through as Step 1.
None of that worked.
Yesterday I read a few posts that mentioned some issues with Steam Community and Steam Cloud. When I got home, I went and disabled Steam Community features from being activated while in game, and I unchecked the Steam Cloud box in the options settings.
Lo and Behold, I played for 6 straight hours without a single hitch, FPS hit, BSOD, game crash, you name it.
I know this won't work for everyone, but I was flat out amazed that I couldn't play for more than 30 minutes without a crash or BSOD the day before, and simply turning off these two features of Steam made the game rock solid, and far more stable than FO3 was for a long time after release.
It is worth a shot for you folks that haven't tried this yet.