I have seen several PT creations which involve full pictures that are pixel for pixel acurate to some other source image (such as found on the web). They clearly were not made one pixel at a time (the only way to do such manually) as that would take a maddening amount of time to do (especially where dithering is involved as the no exact PT color matches the actual pixel, as dithering is a complicated computer algorithm). Clearly such pictures were not done manually, even with the help of Transparent Windows. They must have been generated it either with an undocumented internal PT function or with the help of an external program that could convert pictures to PT stamps.
There is barely anything documented, including the stamp format. But you can read the code quite easily. Making the stamp isn't the hardest thing by the way. Color palette and dithering are the real problems.
I coded a program that can convert pictures into stamps. It does all the stuff necessary (Dithering, Zipping, Headers, etc.). Currently I can generate 7417 unique colors.