If you ever played a Williams Bally/Midway pinball machine from the 1990s dot-matrix era (Addams Family, Twilight Zone, Attack from Mars, Medieval Madness, etc), all of the artwork and animation for those displays was done entirely by hand in Deluxe Paint Animation for MSDOS.
The features like stenciling and animbrush were incredibly powerful. And with a little bit of extra software the exported files could be converted directly into a format for the game software to use.
I recall PinMAME being a fork of MAME, the UI was identical and they borrowed a lot of cores like the 6809 and various common sound boards that video used, like the Williams Yamaha 2151 and Midway DCS AD2105 DSP.
For a while they tried to keep the manufacturers happy by not allowing modified ROMs to run, I got a special build from the developers to let me run anything I wanted. I think those restrictions do not exist anymore.
I knew Lyman from USENET in the early 90s and then I worked with him at Williams. We started around the same time and got laid off together in '99 when WMS shut us down. Lyman was at my wedding.
Sopranos was around the same time, but there were actually two versions of the code. One was in the old 6809 and the other was a test version of their new ARM-based hardware.
I was working on code for a pinball machine for Stern back in 2005. I had a memory corruption issue and Stern's crusty old 6809 hardware didn't have anything resembling a real-time debugger that I could use. There was no time or budget to get a 6809 ICE procured and running.
So I loaded up my code in PinMAME and let it run. I was able to watch memory in real time and caught the bug in an afternoon. It would have taken me a week or so doing it by hand.
I'm friends with someone that worked at Atari around that era and he'll be the first to tell you it was a very loose atmosphere there.