If anyone is interested in an alternative, I have a Sytrin VF1 on my X1900XT now. After installing it my card idles at 38c and gets around 68-69c under load with the fan set on low. I did some temp logging with ATI Tool for comparison and the stock fan would go from idling at 56c up to 86c in about 4 minutes and never really get any higher. With the Sytrin after 35 minutes of running rthdribl fullscreen at 1280x1024, 69c was as high as it ever got. For a direct comparison 4 minutes in it was at 62c with the Sytrin.
The Sytrin does have some downsides though.. the screws mine came with seem to be the wrong size for an X1900XT. They have a rounded top on them that keeps the heatsink from making proper contact (at least with my Sapphire card). I found some screws laying around here with a flat head on them though so that was no big deal for me, but its something to keep in mind. The instructions are also wrong, you have to use the Nvidia clips since the ATI ones won't line up with the mounting holes properly. That is kind of obvious though without needing instructions by just looking at it. Also another minor annoyance is putting the crossflow fan holder on since it shares the screws with the videocard where it mounts to the case. It probably goes on easier with single slot videocards since it wouldn't have to share a screwhole then.